Is psychotherapy passe?

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  • Is psychotherapy passe?

    Once upon a time, I had a full-time job with paid health benefits, including 20 therapy sessions a year through the HMO. I always took advantage of the sessions, even though the therapists were sometimes odd or barely competent; I don't remember any breakthroughs but it was good for the soul to vent about what was bothering me in those days.

    But now? I hardly ever hear anyone talk about counseling or therapy to help them with challenges in life. It seems so much more specialized now, targeted more for handling substance abuse. I do know people who take antidepressants but they rarely seem to mention going to counseling for support.

    I think a lot of people seek support and sympathy online now rather than sitting down with someone in an office to talk. And again, it seems that type of counselor isn't that easy to find anymore unless there's a crisis of some kind.

    I went through a rough patch recently and thought about reaching out. I asked around, people suggested twelve-step/support groups, book clubs, and "church groups." Nobody seemed to know of any therapists to recommend.

    Finally I contacted an astrologer whose blog I like and had a phone reading. We talked, it was helpful.

    So are the days of lying on the couch over, when a la Woody Allen you could free-associate, open up about your inhibitions and heal your demons? What do you think, and if not where do you find people turn instead when they need some psychic healing?
    Last edited by castilleja32; 04-12-2016, 11:47 AM.

  • #2
    Re: Is psychotherapy passe?

    Meditation (and transcendental meditation if you want to spend $$$)
    Yoga
    Tinder.

    Comment


    • #3
      Re: Is psychotherapy passe?

      I still hear plenty of people recommend therapy. I've never known people to have specific therapists to recommend, though.

      My HMO tends to push people toward group therapy or support groups rather than individual counseling, though I think that's just about keeping their costs down. It does seem like more specific therapies like CBT are on the rise as opposed to free-form "talk therapy," but it's still around.

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      • #4
        Re: Is psychotherapy passe?

        Interesting question. I know people who talk to a psychologist and go to a psychiatrist for medications only. I wonder how many psychiatrists are still doing psychotherapy and how many are mostly regulating people's brain chemistry.

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        • #5
          Re: Is psychotherapy passe?

          When I was in medical school about thirty years ago, psychotherapy was still a routine part of a psychiatric visit. At least, that is how it was at our medical school. The visits were fairly short if they were follow-ups. But talking was still part of the therapy. We definitely used medicines, but discussion was important, too.

          Nowadays it seems that the model tends to be for psychologists (with bachelor's, master's, PhD degrees) to do the psychotherapy and for psychiatrists (physicians) in the same office to coordinate matters and write prescriptions. Honestly, I do not know to what extent this is really the current method of providing care, but others have told me that this is the direction that psychiatry took after my medical school years.

          As a family physician, I tried to provide psychiatric care exclusively a few years ago. Because of insurance company policies about who could be paid, I had to give that up. However, I can tell you, based on my own experience and on my reading, that psychiatric drugs do work. Nonetheless, many patients need to be in some kind of psychotherapy also. You get much better results in a large subset of patients when drug therapy and counseling are combined. Of course, some people really do not need the drugs; they just need to talk. And other people need the drugs.

          I think that our approach in psychiatry was better in my medical school years than it is now, unlike the situation in some other branches of medicine, where the practice now is far superior to what we did.

          My answer would be yes, that psychotherapy is passé, but only because people view it that way, not because it deserves to be cast aside. You learn a lot when you talk to troubled people. You may learn, for example, that the chronically depressed patient before you, with poor self-esteem, had a mother who was always depressed, did not show affection, and essentially hated him, for some reason or another. Psychiatric drugs can help a patient like that (and could have helped the mother, too). But the counseling needs to go with it.

          Peace.

          "The fact that you have seen professionals write poorly is no reason for you to imitate them." - ComicBent.

          Comment


          • #6
            Re: Is psychotherapy passe?

            As described, what becomes of such a "chronically depressed patient"?
            Hard to say. We have a standard description for a common event in medical practice: "Patient lost to follow-up" - which means, the patient disappeared. It is very common. All too often the doctor never knows what became of a patient.

            Some people stay in treatment for years. Some become very stable and only need to come in for occasional maintenance, just like with your car. But even those are sometimes lost to follow-up. People move. Or they decide to try another doctor. Then they come back. Then they move. Who knows?

            The important thing is to get people to live day by day and to keep things in perspective. Therapy helps in that.

            Anyway, in my opinion, psychotherapy still has a role to play in psychiatric treatment.

            "The fact that you have seen professionals write poorly is no reason for you to imitate them." - ComicBent.

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            • #7
              Re: Is psychotherapy passe?

              ... but what of the hypothetical patient ... who has no health care? They die. They probably die of easily treatable illnesses, too. The hypothetical patients contend with a society that shuns them for an inability to pay for medical treatment.
              You are preaching to the choir, brother.

              The actual morbidity and mortality rates for these cases are impossible to assess. A lot of the time what happens is that the patient waits until a condition has become very bad before coming to the hospital ER for help. Or the condition is something acute and serious and no waiting is possible. In either case, the patient shows up in an ER and gets admitted to the hospital.

              When that happens, it is unlikely that the hospital will be paid. It varies. Sometimes people pay something every month; sometimes they just disappear, or they keep coming back to the ER for various things and build up a debt that they can never possibly pay. The doctor will almost certainly not get paid. It is also really difficult to transfer an uninsured patient to another hospital, and sometimes a transfer is necessary for appropriate treatment because the first hospital is small and does not have any specialists except maybe a general surgeon. I have been in that situation many times, the situation of having a really sick patient who needed specialized care and it was impossible to find a bigger hospital to take the patient.

              That is America and the American Disease. Done Deal Pro does not permit discussion of religion and politics (a prohibitive policy that I supported when I was an administrator here), so I am not going to post anything else in this thread. However, if anyone out there wants to discuss any of this with me, you are welcome to send an email to me at:
              [email protected].

              "The fact that you have seen professionals write poorly is no reason for you to imitate them." - ComicBent.

              Comment


              • #8
                Re: Is psychotherapy passe?

                Is psychotherapy passe? I couldn't say. But, from several things I've read and heard recently, it seems that at least one form of psychotherapy - CBT (Cognitive Behavioural Therapy) - is increasingly 'trendy'.

                BTW, if you're able to access the BBC iPlayer, this series of radio programmes is very interesting ...
                In Search of Ourselves: A History of Psychology and the Mind
                http://www.bbc.co.uk/programmes/b041...pisodes/player
                .
                Know this: I'm a lazy amateur, so trust not a word what I write.
                "The ugly can be beautiful. The pretty, never." ~ Oscar Wilde

                Comment


                • #9
                  Re: Is psychotherapy passe?

                  Psychotherapy is pseudoscience. You really have to study it a bit to realize that. In fact the people who study it, the NIMH have in the past few years taken drastic steps to distance themselves from the DSM, because it is an arbitrary relic from a century ago (literally a century ago, that is not an exaggeration) that has no basis in science and their research does not support the same conclusions. Thats not to say that there isn't such thing as mental illness, its just that our understanding of it hasn't kept up with the times and the research. For instance schizophrenia and autism, two of the genetic disorders which are actually supported by science (as opposed to "personality disorders", which are complete nonsense) are actually based on a variety of, i think 18 different genetic markers and a whole epigenetic cluster**** of circumstances that have to happen for those genes to actually express themselves. So its a whole lot more complicated than just "you have a chemical imbalance and we need to balance it" which is hugely reductionist, and you're just as well off checking your thetan levels for alien souls or whatever the hell crap scientology is pushing.

                  And when you really look at it, stuff like the rosenhan experiment or the stanford prison experiment or the declassified documents of things like MKULTRA really show how ****ing incompetent and poisonous the psychological industry is, just as poisonous and fictional as scientology. Its one of those things that is based on a bunch of popular conjecture, whatever fashionable conjecture all the 'professionals' agree on, and is really impossible to study because of something called reflexivity, which there is absolutely no way to account for in terms of creating a control group, besides completely non-consensual experiments the patients are completely unaware of (again, see MKULTRA for why this still has been 100% unsuccessful)

                  thats not to say as writers there is not a lot of benefit to be had from studying the mind, but i would say you should actually be a study of the human condition firsthand rather than exploring the books and sources most psychologists study from, which is hugely misleading, (a lot of P-hacking, too, if you know what that is) based on a lot of propaganda from the pharmeceutical and insurance industries. I think whenever anything becomes "fashionable" about psychology, its immediately apparent that its completely full of crap and made to scare moms into stuffing their kids full of pills, which is actually a hugely profitable market. So for it to be passé, it needs to be fashionable first, so it needs to be full of crap.

                  There is one book that is really useful by daniel khaneman, but a lot of what is wrong with the psychiatric industry is actually based on misinterpretations of his work. for instance the whole idea of the "rational" and "irrational" sides of the brain is based on his discovery of system one and system two, which respectively work as a serial and parallel processor, which for someone who doesn't understand what a serial and parallel processor is, is really hard to understand for simpler minds. And i think a lot of good, the reason he was so capable came from studying the minds of people who study minds, because it allowed him to ask the right questions about his own thinking, what am i inserting into this process? And then there are some people who have this sort of intuitive look into the human mind like robert ludlum, whose writing constantly explored a really accurate and gripping look into the minds of people wrestling with their own traumas, and you could diagnose his characters all day but what really made them great was his empathy and his ability to actually put himself in their shoes. His ability to explore them as a person and not a condition, that was what he did immaculately. And he didn't need a phd in psychology to do it, just observance.

                  So, i think really the best things about psychology, which is not really psychology so much as a study of the human condition, are really timeless, and people have been doing it right since the homeric myths, and even before. The whole field of psychology and everything that is fashionable or passé about it, really just distracts from the substance that makes that kind of study worthwhile.

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                  • #10
                    Re: Is psychotherapy passe?

                    Originally posted by castilleja32 View Post
                    ... What do you think, and if not where do you find people turn instead when they need some psychic healing?
                    twitter and facebook. (i don't mean that as a snarky answer btw). the power of social connection is a well known and studied phenomena in the process of healing. as humans it heals us to feel connected when we face tragedy, confusion, suffering; and on the flip-side, our positive interactions such as pride in one's accomplishments, joy, respect, identity, kinship, etc. although we still obviously have counselors and counseling as you mentioned in op, i feel in many ways these social engines have fulfilled a greater societal need and cost less than an HMO.
                    life happens
                    despite a few cracked pots-
                    and random sunlight

                    Comment


                    • #11
                      Re: Is psychotherapy passe?

                      I don't think psychotherapy is passe but I do think the word "passe" is passe.

                      Comment


                      • #12
                        Re: Is psychotherapy passe?

                        Originally posted by flightspace View Post
                        Psychotherapy is pseudoscience. You really have to study it a bit to realize that. In fact the people who study it, the NIMH have in the past few years taken drastic steps to distance themselves from the DSM, because it is an arbitrary relic from a century ago (literally a century ago, that is not an exaggeration) that has no basis in science and their research does not support the same conclusions. Thats not to say that there isn't such thing as mental illness, its just that our understanding of it hasn't kept up with the times and the research. For instance schizophrenia and autism, two of the genetic disorders which are actually supported by science (as opposed to "personality disorders", which are complete nonsense) are actually based on a variety of, i think 18 different genetic markers and a whole epigenetic cluster**** of circumstances that have to happen for those genes to actually express themselves. So its a whole lot more complicated than just "you have a chemical imbalance and we need to balance it" which is hugely reductionist, and you're just as well off checking your thetan levels for alien souls or whatever the hell crap scientology is pushing.

                        And when you really look at it, stuff like the rosenhan experiment or the stanford prison experiment or the declassified documents of things like MKULTRA really show how ****ing incompetent and poisonous the psychological industry is, just as poisonous and fictional as scientology. Its one of those things that is based on a bunch of popular conjecture, whatever fashionable conjecture all the 'professionals' agree on, and is really impossible to study because of something called reflexivity, which there is absolutely no way to account for in terms of creating a control group, besides completely non-consensual experiments the patients are completely unaware of (again, see MKULTRA for why this still has been 100% unsuccessful)
                        Not much of that is rooted in fact and most is hyperbolic and misleading. To be honest, it reflects a severe misunderstanding of the field and the current state of research.

                        Also, Daniel Kahneman's work focuses on behavioral economics and has zilch to do with psychiatry or clinical psychiatry and there is nothing in clinical psych that is based on misinterpretations of any of his work, because there is nothing in clinical psych based on any of his work at all. Totally different research areas (not to mention that a portion of the claims he made in "Thinking..." have since been debunked).

                        I'm an actual research psychologist, so if anyone has any honest questions about the state of psych or psychotherapy, I'll be happy to answer them.
                        Last edited by Optimus; 04-25-2017, 07:53 AM.
                        "Tact's just 'not saying true stuff.' " - Cordelia Chase

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                        • #13
                          Re: Is psychotherapy passe?

                          ... so if anyone has any honest questions about the state of psych or psychotherapy, I'll be happy to answer them.
                          Opty, you do know, don't you, that the forums are shutting down this week?

                          "The fact that you have seen professionals write poorly is no reason for you to imitate them." - ComicBent.

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