![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 26 to 50 of 59. Go back in thread:
Posted by Rzip on February 11, 2001, at 9:56:25
In reply to Re: I put the wrong name on the post , posted by willow on February 11, 2001, at 0:39:57
Willow,
You are a very important poster. Dr. Bob in his article mentioned that all the "very important posters" get to have their name posted in the subject line.
> Have you tried any medications for this?
I do not believe in psychiatric medicines. Maybe in another 50 years or so (if I am still alive), I'll feel more confident about the medications. Right now, too little is known about the neurotransmitters. Just think antidepressive meds were only discovered 50 years ago.
In the 1950s, the drug reserpine was used to treat hypertension. However, the reason the drug worked was because it was depleting the neurotransmitters serotonin, norepinephrine, and dopamine. As a result, people taking reserpine showed classical signs of major depression. So, that promoted scientists to recognize that neurotransmitters were indeed crucial to the onset of psychiatric disorders. Also, it made poeple realize that mood disorders are not predisposed to certain people's brains. I mean, here were these people with a somatic disorder (high BP), and they became depressed because of their neurotransmitter depletion. So, in the 1950-60s, scientists jumped for joy to finally discover certain brain systems that can be targeted for medical treatment.
In the recent decade, SSRIs are now able to target more specifically those presynaptic regions for serotonin reuptake. SSRI= Selective serotonin reuptake inhibitors. So, my case in point is that it is not very advanced medicine to be able to only target a neurotransmitter system. I mean so many pathways are linked to that presynaptic region (hence all the side effects). Case in point: I do not feel secure in taking psychiatric meds. I know that this is a bit long winded way of saying I do not trust P-meds.
> Once I started seeing the psych though I started to analyze everyone's motives. I think it was getting on people's nerves. :) I wonder if anyone else had done this, it was fun for awhile, like a new toy!
I know exactly what you mean. Ever since I started therapy, I have been kind of looking at those around me with the assumption that they all have some psychiatric imbalance. Once I figure out what those people lack (attention needy, power needy, lonliness, for instance), I find that I can interact with them a whole lot better by giving them leeways on those exact issues. Like if my boss is power seeking, I purposely give him a bit more power just to satisfy him (and so he can leave me alone).
> I start thinking of him as a friend, though in reality he really isn't. Does that make any sense?Yeah, I been there. I wanted my former therapist to be more friend so much that it ruined our therapeutic relationship. It is very dis-satisfying to realize that this person who connect so well to you internally and during sessions can not be your friend in the everyday sense. It is very sad. I find myself holding back in therapy now because I do not want to get my hopes up again.
- Rzip
Posted by Rzip on February 11, 2001, at 9:57:17
In reply to Re: opps ! Sorry !, posted by pat123 on February 11, 2001, at 0:55:20
> > You asked the question "why don't most of you take me seriously ?";
>
> Opps ! It seems I took your post too seriously or at face value and missed the humor. I wish I had
> just waited till another had posted and then the light bulb would of gone on, I'm sure. I'm really sorry for what I said, Rzip. I took your post in a way that you did not intend.
>
> Pat
Posted by allisonm on February 11, 2001, at 12:22:33
In reply to Willow » willow, posted by Rzip on February 11, 2001, at 9:56:25
> > > I do not believe in psychiatric medicines. Maybe in another 50 years or so (if I am still alive), I'll feel more confident about the medications. Right now, too little is known about the neurotransmitters. Just think antidepressive meds were only discovered 50 years ago.
>Yea, but penicillin was introduced only 60 years ago, and other versions still were being developed in the 1950s and 1960s...
I think radiation and chemotherapy still are crude therapies for cancer, but they are all there is right now, besides surgery. Heck, I think surgery is crude and invasive. Imagine what they'll all be like in 50 years.
I guess if one doesn't feel terribly bad he/she can avoid meds. But if one cannot function well, why suffer through it? No doubt you have heard this ad nauseam, but it's a quality of life issue for me. I don't want to feel horrible for 80 years if I can feel pretty good for 60 or 70. And I wonder if I feel that horrible whether I'd even make it to 80; the stress of living with a mental illness might take more years off my life than would any possible side effect from the drugs to get rid of it.
Best regards,
Allison
Posted by willow on February 11, 2001, at 13:08:18
In reply to Re: You guys are lucky ... » willow, posted by NikkiT2 on February 11, 2001, at 7:24:15
"Its a 9 month wait for the day hospital!!! great eh!"
Sounds like you are enjoying the priviliges of a "socialist" health care system in Canada? I'm not against it, but it does have its drawbacks.
The government will put help out there to get more nurses etc for physical ailments, but we also need more mental health professionals. In Northern Ontario, which covers a large area, we don't even have a child psychiatrist I believe and if we do than we don't have enough. ;)
Are you in Canada?
Posted by julesvox on February 11, 2001, at 13:53:38
In reply to Ok. Apology accepted. » pat123, posted by Rzip on February 11, 2001, at 9:57:17
what's the documented t-shirt phenomenon you mentioned earlier?
Posted by NikkiT2 on February 11, 2001, at 13:57:15
In reply to Only in Canada, Nikki ?, posted by willow on February 11, 2001, at 13:08:18
Nope. I'm in the great UK!!! :o) I live in London, so you would have thougt there be more than enough psych help!! But barely anything!
Posted by NikkiT2 on February 11, 2001, at 14:00:23
In reply to Re: opps ! Sorry !, posted by pat123 on February 11, 2001, at 0:55:20
Well, I know I will be checking what my pdoc is wearing next time I see him!! :o) I honestly can't remember what he ahs ever worn... I think I focus on his desk and amaze that there is no pc on it!!! LOL And trying to understand his thick indian accent!! I know he has problems understanding mine too!!! makes for a *great* relationship!!! ;)
Nikkix
Posted by willow on February 11, 2001, at 17:21:08
In reply to Willow » willow, posted by Rzip on February 11, 2001, at 9:56:25
All afternoon I've been taking little stints, meanwhile offline, writing a reponse. Probably my lengthiest piece. I noticed a spelling error so I thought I'd go back and correct it. The whole thing was gone.
Has this happened to anyone else?
Oh, well from now on the typos remain ...WEEPING WILLOW
Posted by willow on February 11, 2001, at 18:22:05
In reply to Willow » willow, posted by Rzip on February 11, 2001, at 9:56:25
"(if I am still alive)"
How old are you, if this isn't too personal of a question? Once my children realized that people don't live forever they became quite concerned. I later told them they would probably live to 120, because of all the gains in medical knowledge. For you if you're in your 20's it's probably around 100. Still alot of living!
" ... presynaptic regions for serotonin reuptake. SSRI= Selective serotonin reuptake inhibitors."
I still don't really understand what SSRI really means and in my present condition the how and why doesn't concern me as much as that it does work.
"Case in point: I do not feel secure in taking psychiatric meds."
I don't blame you. I think it would be arrogant on our part to think we understand everything about how medications interact with our bodies. For myself the present is more pressing than the future or the benefits are outweighing the risks. This is what Allisonm was getting at I think.
"Once I figure out what those people lack (attention needy, power needy, lonliness, for instance), I find that I can interact with them a whole lot better by giving them leeways on those exact issues."
Now this is an example of insight. I too starting doing this but I have a problem with verbal diarrhea. I'm learning to think a little quieter now.
"It is very dis-satisfying to realize that this person who connect so well to you internally and during sessions can not be your friend in the everyday sense."
Yes, but are they being totally honest of their thoughts in a session or are they programmed this way through their training?
Posted by allisonm on February 11, 2001, at 20:01:18
In reply to RZIP : ) , Allisonm , and others ..., posted by willow on February 11, 2001, at 18:22:05
> " ... presynaptic regions for serotonin reuptake. SSRI= Selective serotonin reuptake inhibitors."
>
> I still don't really understand what SSRI really means and in my present condition the how and why doesn't concern me as much as that it does work.When serotonin is produced, it stays in your brain for a certain amount of time before it is disposed of (reuptake). SSRIs delay the reuptake of serotonin, causing more serotonin to be in your brain at any given time, causing an elevated mood.
> > For myself the present is more pressing than the future or the benefits are outweighing the risks. This is what Allisonm was getting at I think.< <
You said succinctly in one sentence what I wasted many paragraphs trying to say. Thank you.
>
> Yes, but are they being totally honest of their thoughts in a session or are they programmed this way through their training?< <That's a good question. I wish you hadn't asked it. I want to think that my pdoc likes talking to me and isn't faking that, but who knows when you're operating in the valley of "unconditional positive regard?"
Posted by willow on February 11, 2001, at 21:37:20
In reply to Re: RZIP : ) , Allisonm , and others ... » willow, posted by allisonm on February 11, 2001, at 20:01:18
"When serotonin is produced, it stays in your brain for a certain amount of time before it is disposed of (reuptake). SSRIs delay the reuptake of serotonin, causing more serotonin to be in your brain at any given time, causing an elevated mood."
Okay I can understand that, but does the medication have serotonin in it? And what is serotonin? And why isn't effexor an SSRI?
PS You explained the SSRI thing so that I could understand, hope you don't mind the added questions.
"I wish you hadn't asked it."
Sorry Allisonm! My husband and I were enjoying popcorn one night, funds were tight. He was so enjoying it and what blurts out of my mouth? It sure isn't our favourite take-out pizza. If looks could kill I wouldn't be writing now! :(
"I want to think that my pdoc likes talking to me and isn't faking that, ... "
Me too! That's what bothers me about the whole thing. Before I had let a cuss slip meanwhile I was zapping away. I immediately covered my mouth and apologized. He had questioned how comfortable and open I was. At the time I had questioned who would be comfortable talking about themselves to a complete stranger? (Which he really isn't in a way. He was affiliated with the psychologist I saw as a teenager and this is the one of the reasons I chose him out of the three licenced ones here in town. He already knew my history. It's not something that I talk about to acquaintances even.) Anyway, so I start opening up and he acts interested etc, but the psych isn't a friend, right? It adds confusing emotions into an already confused mind.
Maybe I'm "analyzing" too much into it? Maybe I should just enjoy it as it is?
Posted by Rzip on February 11, 2001, at 23:34:05
In reply to what's the documented t-shirt phenomenon? (nm) » Rzip, posted by julesvox on February 11, 2001, at 13:53:38
> what's the documented t-shirt phenomenon you mentioned earlier?
Staff in the inpatients (crisis intervention) ward should not wear ties, shirts with lots of buttons, or necklaces. Patients who are violent going into lock-down/seclusion rooms tend to grab at the staff's clothing. Hence to avoid a choking hazard, staff members there are encouraged to wear T-shirts.
- Rzip
Posted by Rzip on February 11, 2001, at 23:38:39
In reply to Rzip, posted by allisonm on February 11, 2001, at 12:22:33
Yeah, the medicine issue is a big internal struggle for me. Right now, I plan to just stick with talking therapy. We'll see.
Thanks,
Rzip
Posted by Rzip on February 12, 2001, at 0:10:48
In reply to Re: RZIP : ) , Allisonm , and others ..., posted by willow on February 11, 2001, at 21:37:20
> does the medication have serotonin in it? And what is serotonin?The SSRI medications do not have serotonin in it. It blocks the reuptake of serotonin in the bridge between pre-synapsis and post-synapsis. It's kind of hard to explain, but I'll try. See, serotonin (which is a neurotransmitter-- think of it as a baseball).
In this game, you have a toss machine (pre-synapsis); 10 baseballs (serotonin neurotransmitter); 5 kids who runs around and picks up the balls that were not caught by the catcher (the reuptake mechanism-- area of interest); and finally, the catcher (post-synapsis). So, usually the kids are supposed to pick up the baseballs and put them back into the toss machine. However, one day a clown came into town and started engaging the kids in games, so the kids neglected their baseball duties. The clown in this analogy is the SSRI's. They prevent the reuptake of the serotonin (baseball). So, now you have more baseballs lying in the playfield and the analogy falls apart here :-(
O.K. scientifically, the serotonin lying in the "baseball playfield" is associated with mood upswing. So, that is why SSRI are good anti-depressants; they allow the serotonin to float in the "playfield". Selective Serotonin Reuptake Inhibitor = SSRI. Does that help?
> Maybe I'm "analyzing" too much into it? Maybe I should just enjoy it as it is?Analyze at your leisure. If it stops being pleasant, just stop analyzing. In general, IMO, therapy is supposed to make you more insightful and thought-provoking. Thinking is good. But, too much internal thoughts and over-imagination as in MY case, is bad. How does the saying go? Avoid too much of a good thing, exercise moderation...
- Rzip
Posted by dj on February 12, 2001, at 1:26:46
In reply to Re: RZIP : ) , Allisonm , and others ..., posted by willow on February 11, 2001, at 21:37:20
> > the psych isn't a friend, right? It adds confusing emotions into an already confused mind.
>
> Maybe I'm "analyzing" too much into it? Maybe >I should just enjoy it as it is?Contrary to RZip's comments my interpretation would be that your comment above is dead on. The point is to feel the feelings, not to think the feelings. To acknowledge them, to consider them, to enjoy them but not to obsess about them and what happened or did not happen.
A very good group facilitator whom I know and respects once told some friends and I the story about how when she realized she was warm for her therapist's form (ie. - she was having fantasies about her relationship with him, a very nice and reputable guy, whom I also know) and decided to tell him as much during their session. He looked at her, commented: "How nice for you." and the session continued or ended as per usual.
She was pissed at him for awhile until she decided he was right and decided to enjoy her fantasies, as such. How nice for her, as she came to appreciate things as they were, not as she wished they were...!
Posted by coral on February 12, 2001, at 7:32:45
In reply to Re: RZIP : ) , Allisonm , and others ... » willow, posted by allisonm on February 11, 2001, at 20:01:18
Re: Seeing your therapist in a social setting outside of work - I don't know about other states but in Michigan, if your therapist sees you first, he/she isn't allowed to even greet you, unless you greet them first. It's their professional code of ethics. I ran into my therapist at a store check-out line. He saw me, did a double-take and said, "Hi," then, he blushed.... paid for his purchases and left. I was seeing him that day and he apologized for speaking to me. I was floored. He explained the state's code of ethics and the intentional non-recognition is for the privacy of the client.
Posted by allisonm on February 12, 2001, at 8:09:08
In reply to Re: seeing therapist outside of work, posted by coral on February 12, 2001, at 7:32:45
As I was boarding a plane with my husband three years ago, I saw my psychiatrist already seated farther back. I did a double-take, froze and stared, looked at the man he was seated with, looked back at him, then nodded once. He nodded once in reply, and that was it. I was mortified for most of the rest of the flight.
I have wondered about who his traveling companion was. I am quite sure they were traveling together because they were the only ones seated back there and were sitting together. He was on his way to Nassau on vacation.
I wish I hadn't seen him outside of the office. It raised too many questions in my mind and has been a distraction.
Posted by allisonm on February 12, 2001, at 8:59:02
In reply to Re: RZIP : ) , Allisonm , and others ..., posted by willow on February 11, 2001, at 21:37:20
> > > Okay I can understand that, but does the medication have serotonin in it? And what is serotonin? And why isn't effexor an SSRI? You explained the SSRI thing so that I could understand, hope you don't mind the added questions.< <
If you don't mind an oversimplified version from a laywoman, here goes...
Mood is affected primarily by three chemicals in your brain: serotonin, norepinephrine, and dopamine. Some folks with depression may need more norepinephrine and less serotonin and dopamine. Others might need more serotonin, etc.
Drugs affect the level of these chemicals in varying degrees by regulating the different neurons/synapses in your brain that take each of these chemicals up (there are different ones for each chemical). They can act on one or two of the chemicals or they can act on all three, but usually if they act on all three, they have a stronger effect on one or two of the three. They also effect the brain in other ways by causing other chemical changes. This is the most simple way I can explain it.
So then it becomes an educated guessing game to see which chemicals in each person's brain need boosting. Effexor, for example, works more on norepinephrine and serotonin. Reboxetine is an NRI -- a norepinephrine reuptake inhibitor. Remeron affects all three, but not so much on serotonin. Celexa is considered different from SSRIs because it is "clean" and works only on serotonin reuptake. Wellbutrin works, but they don't know how yet. I think it has something to do with dopamine and norepinephrine.
Doctors have a series of drugs they usually try according to the symptoms. For depression, they often will try one or more SSRIs first, then Effexor and/or Remeron, for example. If they get a partial response, they may increase the dose. Then they may augment with another drug such as lithium or Wellbutrin because those seem to boost the effectiveness of other drugs. Or they could add another AD. They also could add a mood stabilizer. They may try the older types of drugs -- tricyclics and MAOIs, which can be very effective for some people. I think Scott (aka SLS) wrote a really good explanation a while back on how MAOIs work. You might do an archive search for it.
To find what the different drugs work on, you also might go to: http://mentalhelp.net/guide/pro22.htm
which lists most all of the psychopharmacologic drugs and gives online sources that have descriptions of each. I usually try the Rxlist first if I am looking up a drug. If you go to the Rxlist for a particular drug, go to the clinical pharmacology section at the top of the page, and that will tell you how the drug works. If you run into words like "noradrenergic" and "adrenergic," they have to do with norepiniphrine. "Serotonergic" has to do with serotonin."Dopaminergic" has to do with dopamine.> > "I wish you hadn't asked it."< <
I was kidding -- mostly -- when I said that. It is a constant thought in the back of my head that the relationship between me and my psychiatrist is not real. There is a book out called "Mockingbird Years" by Emily Fox Gordon in which the author describes her life and all of the therapists she went through. She said something that still bothers me: "...therapy was a sad, manipulative parody of authentic relation." I don't want to believe that.> > > so I start opening up and he acts interested etc, but the psych isn't a friend, right? It adds confusing emotions into an already confused mind.< <
I agree a zillion percent.
> > > Maybe I'm "analyzing" too much into it? Maybe I should just enjoy it as it is?< <
I don't have an answer to that because I probably analyze too much too.
Posted by coral on February 12, 2001, at 10:58:21
In reply to Willow, posted by allisonm on February 12, 2001, at 8:59:02
I may be the odd one out here, but I don't want my therapist as a friend. I respect him tremendously, find him insightful, respectful, intelligent, charming, warm, generous and intensely concerned about my welfare. All of the characteristics that would be desirable in a friend. However, I selfishly guard my therapeutic time to help me get better. I love the freedom of being able to say exactly what's on my mind without ANY of the concern one would have if speaking to a friend.
My gynecologist and I share the same social circle and are friends outside of the office. We were sitting together at a friend's wedding and he said, "It's hot in here." Turning to me, he continued, "Are you ovulating?" Laughing, I said, "How in hell would I know? You're the gynecologist!"
Posted by willow on February 12, 2001, at 12:20:51
In reply to Re: Rzip » allisonm, posted by Rzip on February 11, 2001, at 23:38:39
Check out the link DJ made below in his post "Active Treatment of Depression." You may be on the right path?
Posted by allisonm on February 12, 2001, at 12:34:19
In reply to Re: therapist as friend, posted by coral on February 12, 2001, at 10:58:21
> > I may be the odd one out here, but I don't want my therapist as a friend. I respect him tremendously, find him insightful, respectful, intelligent, charming, warm, generous and intensely concerned about my welfare. All of the characteristics that would be desirable in a friend. However, I selfishly guard my therapeutic time to help me get better. I love the freedom of being able to say exactly what's on my mind without ANY of the concern one would have if speaking to a friend. < <
Coral,
You're not the odd one out at all. I agree with you. I wouldn't be getting anywhere at all in therapy were I real friends with my psychiatrist. We wouldn't be able to have the conversations that we do. I too relish being able to say anything to him without having to worry that I'm saying it to a friend because we're not. Sometimes I think it bothers him more than it bothers me when I get irritated with him, or at least he acts that way.
On the other hand, he knows as much or more about me than my best friend does. And he's always nice to me. So it's a weird feeling having someone know that much and not be your friend. That's what makes me question whether his thoughtfulness, friendliness, and concerned and caring attitude are real. How could it be real? Maybe it's all a big act designed to get more information out of me. Is it just a job? How detached are they from us?
I often have wondered what kind of person my psychiatrist is outside of his office, and what his interests are. Is he the same kind of person that I see in his office? Maybe he's an arrogant, short-tempered, bossy, egotistical jerk. Or maybe he's a nervous, perfectionistic, introverted nerd.
They say patients tend to pattern themselves after their therapists. Maybe therapists pattern themselves after each patient to make them feel like they're with a likeminded person so they will talk more openly. I like poetry, for example. Is that why he reads poems to me in our sessions or does he like and find some connection in poetry too? We both love bookstores, allegedly. I have a weakness for gardening books. He says he likes them too, but does he really?
Like Willow, maybe I am overanalyzing. It's hard not to when a person has that much influence over you.
Thanks for writing. This is an interesting discussion.
Posted by Cass on February 12, 2001, at 15:11:25
In reply to Dr. Bob: Why do psychiatrists wear blue shirts?, posted by Rzip on February 9, 2001, at 23:24:03
I've been seeing my doctor for over a year. I usually look directly at him, but I can't remember one single shirt of his. What does that mean? Hmmmm.
Posted by Rzip on February 12, 2001, at 16:45:45
In reply to Re: Dr. Bob: Why do psychiatrists wear blue shirts?, posted by Cass on February 12, 2001, at 15:11:25
> I've been seeing my doctor for over a year. I usually look directly at him, but I can't remember one single shirt of his. What does that mean? Hmmmm.
You have more important things on your mind than the color of your therapist's shirt :-)
It probably means that your sessions are very focused and intense. That's my take on it.
- Rzip
Posted by Rzip on February 12, 2001, at 16:47:05
In reply to Re: Rzip - medication, posted by willow on February 12, 2001, at 12:20:51
> Check out the link DJ made below in his post "Active Treatment of Depression." You may be on the right path?
Posted by dj on February 12, 2001, at 18:27:53
In reply to Thanks. (np) » willow, posted by Rzip on February 12, 2001, at 16:47:05
> > Check out the link DJ made below in his post "Active Treatment of Depression." You may
> be on the right path?On his website (http://www.undoingdepression.com) Richard O'Connor makes both the case for and against ADs, as I suspect he does in his newest book on the "Active Treatment of Depression."
RZip I imagine you will revel in the very detailed analyis O'Connor lays out in the intro. and 1st Chapter as laid out at the url, cited below and I'd be interested to hear what your take is on it all. For those who are not inclined to fully engage in it here's an excerpt from the into. which provides a bit of an overview on O'Connor's take on things:
""I am a therapist who suffers from depression myself. I have tried to write something that will be practical and helpful to therapists, physicians, and pharmacologists who are trying to help patients who do not respond quickly or easily to the standard prescribed treatments. Unfortunately, research is confirming that these are the majority of people suffering from depression. As I did the literature review for this book, I found myself more and more concerned that most care for depression is superficial, inadequate, and based on false information. Many assumptions commonly held in the professional community—that newer antidepressants are reliably safe and effective, that short-term cognitive and interpersonal psychotherapy help most patients, that many people with depression can be effectively treated in primary care, that most patients can recover from an episode of depression without lasting damage—on close examination turn out not to be true at all. And practice based on these assumptions is not only inadequate for treatment of depression, it can actually exacerbate the disease.
Most therapists and psychopharmacologists can help a patient recover from a single episode of depression, but our relapse rate is far too high: Patients who have one episode of major depression are 50 percent likely to have another; patients who have three episodes are ninety percent likely to have more (Thase, 1999). And, if we are honest with ourselves, we will also admit that our batting average is not so good either; for every patient we can help, we probably see two whom we can't. Active Treatment of Depression suggests that we accept the idea that depression is a chronic disease, and that we help our patients plan their lives accordingly. Medications are usually helpful and often will be a part of the patient's life for some time to come, but rarely can they prevent future episodes and help the patient resolve the problems that led to trouble in the first place…
The ugly fact is that too much of treatment for depression only reinforces the disease. Any experienced therapist has encountered patients who have been damaged by previous treatment, sometimes by highly qualified practitioners. Analytic therapy has reinforced depression in some who become mired in rumination. Directive treatment has demoralized and shamed patients by sadistically attacking their defenses. Medication, even when effective, can reinforce passivity. ECT can do the same. Yet all of these approaches also can be beneficial, with the right patient at the right time. How do we understand this?
I urge the reader to accept the fact that no single theory can yet explain this complex condition that affects twenty percent of the population. In fact, trying to understand depression exclusively from a single perspective—for instance, a cognitive-behavioral, psychodynamic, or a biochemical point of view—will necessarily limit our understanding and our ability to help our patients. Rather, we must be willing to take the best knowledge from many different points of view and shape it into practice guidelines. In doing so, we must also practice "active treatment" because many of our customary ways of operating are counterproductive with depression...
.... Depression is more difficult to treat than we want to acknowledge. Everyone believes that research has demonstrated that cognitive behavioral therapy, interpersonal psychotherapy, and medication are demonstrably and equally effective in treating depression. But that was at three months after treatment. At eighteen months, not a single one of the patients, no matter what treatment they'd received, were any better off than the control group (Shea et al., 1992). In order to truly help people who are suffering with this venomous and insidious condition, we have to be willing to challenge some of the assumptions we hold dear. I hope the reader will bring an open mind. I have attempted to present a reasonably thorough and objective review of the current state of knowledge, and I hope that the result is both reliable and provocative.
Much of what is to follow is rather prescriptive. I don't want to gloss over the individual differences between patients and between therapists. Any therapeutic dyad is a highly unique entity. Each therapist is—or should be—struggling with his own uncertainty, how to help this patient in this situation given the limits of his professional knowledge, his incomplete understanding of the patient, the constraints of the therapeutic relationship, and individual biases and anxieties. I'm trying to give advice to the therapist based on my own perspective about depression, advice that hopefully informs and enlightens without ignoring the uniqueness of the patient-therapist situation and without ignoring the complex, unfathomable, potential of human existence. I do not believe it is helpful for our profession to pursue the belief that there is one, and only one, technically correct intervention at any given point in time in a therapeutic relationship. Rather, there are infinite interventions, some more helpful than others. But even the most helpful interventions have the effect of constraining the future dialogue, of co-constructing a reality that will have an impact on the future that is impossible to predict with reliability. When the patient has depression, that new, constructed reality must provide a different perspective: hope, alternatives, openings, even wisdom and power. To settle for less is to sell the patient short.."
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