![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 16 to 40 of 44. Go back in thread:
Posted by floatingbridge on November 21, 2009, at 21:16:31
In reply to Re: No benefit to adding psychotherapy to medication » morganator, posted by SLS on November 21, 2009, at 5:46:12
>
> One thing I don't like seeing is a psychotherapist disregarding the biological nature of affective disorders and place the responsibility of mental health on the psyche of the patient. This is a cruel sort of sabotage.
>
>
> - ScottYes, I absolutely agree with you. And here in the sunny west, that attitude has trickled down to the general population of pop-psychology readers. The same attitude that blames a Parkinson's patient for precipitating illness by too much negative thinking, or even, karma!
Yesterday, my pdoc showed me the latest publication on managing major depression (a slim book by some neuroscience organization). Interpersonal therapy--or any therapy--was suggested as an adjunct in the 4th (or last) step in dealing with major depression. Therapy was placed in the same tier as ECT, VNS, and rTMS. I was shocked. I mean, therapy does not help some people, for many reasons--that I understand. To wait to try it until one presents as ready for last and most invasive measures does not seem wise. What a disconnect, imho.
fb
Posted by SLS on November 21, 2009, at 23:23:24
In reply to Re: No benefit to adding psychotherapy to medicati » SLS, posted by floatingbridge on November 21, 2009, at 21:16:31
Hi FB.
> > One thing I don't like seeing is a psychotherapist disregarding the biological nature of affective disorders and place the responsibility of mental health on the psyche of the patient. This is a cruel sort of sabotage.
> Yes, I absolutely agree with you. And here in the sunny west, that attitude has trickled down to the general population of pop-psychology readers. The same attitude that blames a Parkinson's patient for precipitating illness by too much negative thinking, or even, karma!
>
> Yesterday, my pdoc showed me the latest publication on managing major depression (a slim book by some neuroscience organization). Interpersonal therapy--or any therapy--was suggested as an adjunct in the 4th (or last) step in dealing with major depression. Therapy was placed in the same tier as ECT, VNS, and rTMS. I was shocked. I mean, therapy does not help some people, for many reasons--that I understand. To wait to try it until one presents as ready for last and most invasive measures does not seem wise. What a disconnect, imho.Gosh.
What comes with the next tier - positive affirmations and psychosurgery?
You know, it would make a hell of a discussion to consider whether or not psychotherapies should be included in a treatment algorithm for depression, and if so, where they should be positioned.
I favor the use of a psychological evaluation at some point, perhaps as part of an intake process, rather than a rigid placement of psychotherapy in a treatment algorithm. For MDD and BD, I'm not sure there is enough scientific evidence that psychotherapy is effective such that it should deserve a prominent role in treatment. I would prefer to establish an indication for psychotherapy first through psychometric testing or some other form of psychological evaluation. This could help set up a treatment protocol that includes both somatic and psychological therapies.
- Scott
Posted by floatingbridge on November 21, 2009, at 23:55:50
In reply to Re: No benefit to adding psychotherapy to medicati » floatingbridge, posted by SLS on November 21, 2009, at 23:23:24
>
> What comes with the next tier - positive affirmations and psychosurgery?
>Well, sadly, and as you know, right now that is the last tier--though my pdoc seems very excited about what will be happening in the next ten years--he thinks it will be revolutionary. As for the time being....
> You know, it would make a hell of a discussion to consider whether or not psychotherapies should be included in a treatment algorithm for depression, and if so, where they should be positioned.
>A great discussion here. Seems some others have had that discussion already--and sent it out to our pdocs. (Though mine said he was 'agnostic' in regards to the psychiatric community. I suspect many are--I hope.)
> I favor the use of a psychological evaluation at some point, perhaps as part of an intake process, rather than a rigid placement of psychotherapy in a treatment algorithm. For MDD and BD, I'm not sure there is enough scientific evidence that psychotherapy is effective such that it should deserve a prominent role in treatment. I would prefer to establish an indication for psychotherapy first through psychometric testing or some other form of psychological evaluation. This could help set up a treatment protocol that includes both somatic and psychological therapies.
This idea sounds good to me!
:-)
fb
Posted by morganator on November 22, 2009, at 3:23:32
In reply to Re: No benefit to adding psychotherapy to medication » morganator, posted by SLS on November 21, 2009, at 5:46:12
Well I'm glad you have enjoyed some of my posts, thank you. Yours are very insightful and interesting I must say.
I'm too tired to make a long argument but I feel the need to briefly express my opinion on the subject. I believe that with people who have struggled with bipolar and major depressive disorder also did not get what they needed in childhood. Yes there is a biological predisposition, but if people suffering from these disorders had gotten what they needed from day one, I do not believe the suffering would be so severe. Now, the people who do not have the genetic predisposition to develop such severe disorders but are exposed to the same environment in early and later stages of development will still have issues. The difference with these people is that they will be able to continue on through life without their depression and anxiety growing into the monster that feeds on many of us. Look, bad parenting, child abuse, lack of love and nurture have been part of the human condition for a long time. There have been very few parents truly capable of giving their children what they need. We cannot deny that this has not had a major impact on our lives. I think finally now we are learning to truly love ourselves and our children. This generation of parents is much different than those in the past. We are far from perfect but I think we are better off than before. Fathers are more involved and able to show more emotion. People are getting married later so hopefully they will be less likely to get divorced, which by the way is incredibly destructive to the emotional psyche of the children involved. Even if both parents handle the divorce perfectly the children will suffer, maybe not as bad but they will still suffer. It is known that children from divorced parents have problems with anxiety, amongst other potential problems.
I guess I just don't think that it is possible for disorders to develop to such a severe state without environment and nurture playing a significant role. I have had two psychiatrists, not psychotherapists, admit to me that conditions in my childhood very well have made me more likely to experience such extreme mixed states later on. You have to also consider that we may have been more equipped to avoid the stressors that sent us deep into our states of suffering if we had what we needed throughout our development.
We may not have felt the need to use as much alcohol or drugs(which I believe can contribute to episodes). We may have been able to form relationships and maintain them better which would have given us more stability. We may have not carried all the anxiety and anger(by the way, believe it or not, almost all of us carry some anger about something, it's a different kind of anger) that interfered with so many things in our lives. This interference added to the instability that contributed to the suffering. We may have loved ourselves more and been more confident.Scott, while we agree on some things, we may have to disagree on others. Even with schizophrenia it is not inevitable that one will develop it just because they have the gene or the predisposition. The person may be a little different but they may never have a psychotic break given the right conditions.
I would love to hear in detail about the childhoods of all of those suffering from depression, major depression, bipolar, schizophrenia. I can almost guarantee that everyone will have some not so good things to talk about. Some may have some serious trauma. Others may have had a verbally abusive mother or father. Many will have had gone through a divorce. Maybe some never knew their mother or father and the single parent struggled to hold things together. Many may be in complete denial and say that there was nothing wrong with their parents or childhood. Denial is the most powerful of all coping mechanisms.
Oops I lied, I wasn't that tired after all.
Posted by SLS on November 22, 2009, at 6:31:27
In reply to Re: No benefit to adding psychotherapy to medication » SLS, posted by morganator on November 22, 2009, at 3:23:32
You know, I have never seen a study investigating the psychosocial history of people suffering from Axis I mental illnesses as they come in for treatment. Such a study would reveal much about the evolution of these disorders.
I agree with you. Even identical twins can express schizophrenia differently. Again, it would be interesting to try to identify differences in early psychosocial experiences between each individual. Living under the same roof is no guarantee of identical developmental environments. All of these disorders must have some epigenetic counterpart as there is not a one-to-one genotype to phenotype relationship. I don't think we are looking at a simple dynamic, though.
- Scott
Posted by bleauberry on November 22, 2009, at 7:44:50
In reply to No benefit to adding psychotherapy to medication, posted by SLS on November 20, 2009, at 15:27:50
I did psychotherapy twice...weekly for 6 months each time.
It was helpful but only for the half hour or so following the appointment. Ya know, a good counselor can lift your spirits, give confidence, get you relaxed and feeling better. The problem is, as soon as you leave, get in the car and start driving in the real world again, all of that evaporates real fast.
I think the best uses of psychotherapy are:
1. When there is a definite life issue involved...divorce, death, loss of career, etc.
2. For pure biochemical depression without a life crisis component, I think psychotherapy serves a good purpose to help keep the patient on track while waiting for the medicine to hopefully kick in. It's almost kind of like having a cheerleading squad in your corner to send you back into the boxing ring each round with a renewed sense of confidence, hope, and patience. Without the counselor, we might abandon our meds too soon. They can help keep us on the path our doctor has chosen for us, or spot a situation where a doctor has made an obviously gross error.
Posted by floatingbridge on November 22, 2009, at 15:07:00
In reply to Re: No benefit to adding psychotherapy to medication » SLS, posted by morganator on November 22, 2009, at 3:23:32
Morganator,> Oops I lied, I wasn't that tired after all.
:-)
I recently said to a group of 'healthy' friends, when one mom quipped about what her son would take to therapy with him as a grown man, "So, what's wrong w/ therapy? Probably everybody could use some." The group laughed in recognition and agreement--and the mom who spoke said 'Right on!"
fb
Posted by floatingbridge on November 22, 2009, at 15:13:06
In reply to Re: No benefit to adding psychotherapy to medication, posted by bleauberry on November 22, 2009, at 7:44:50
> I did psychotherapy twice...weekly for 6 months each time.
>
> It was helpful but only for the half hour or so following the appointment. Ya know, a good counselor can lift your spirits, give confidence, get you relaxed and feeling better. The problem is, as soon as you leave, get in the car and start driving in the real world again, all of that evaporates real fast.
>
> I think the best uses of psychotherapy are:
>
> 1. When there is a definite life issue involved...divorce, death, loss of career, etc.
>
> 2. For pure biochemical depression without a life crisis component, I think psychotherapy serves a good purpose to help keep the patient on track while waiting for the medicine to hopefully kick in. It's almost kind of like having a cheerleading squad in your corner to send you back into the boxing ring each round with a renewed sense of confidence, hope, and patience. Without the counselor, we might abandon our meds too soon. They can help keep us on the path our doctor has chosen for us, or spot a situation where a doctor has made an obviously gross error.Bleauberry, I'm curious in the context of this discussion--I don't mean to pry--so take a pass on this if you want to. My understanding of your situation is that it derives from, primarily, lymes disease (I could very well be mistaken). Maybe you do not have very much trauma (or life/situational) distress to process? And therefore, maybe not too much maladaptive behavior/cognition?
Best regards,
fb
Posted by SLS on November 22, 2009, at 16:05:50
In reply to Re: No benefit to adding psychotherapy to medicati » bleauberry, posted by floatingbridge on November 22, 2009, at 15:13:06
I don't know if I made this clear earlier, but psychotherapy has never improved my depression in the slightest. However, I try not to extrapolate my experience upon those suffering from all types of depression. Perhaps bipolar disorder, which is what I have, is less responsive to psychotherapy than unipolar disorder (major depressive disorder). I really don't know. Still, there are some pretty compelling reasons to taking advantage of psychotherapeutic counseling. If nothing else, it can help change the content of thought and thus reduce what I like to call "depressive pressure". To reduce depressive pressure can only help and not hurt. It can improve one's chances of responding to drug treatment and reduce the risk of relapse or medication breakthrough after a response is obtained.
- Scott
Posted by floatingbridge on November 22, 2009, at 16:26:37
In reply to Re: No benefit to adding psychotherapy to medicati, posted by SLS on November 22, 2009, at 16:05:50
> I don't know if I made this clear earlier, but psychotherapy has never improved my depression in the slightest.
However, I try not to extrapolate my experience upon those suffering from all types of depression. Perhaps bipolar disorder, which is what I have, is less responsive to psychotherapy than unipolar disorder (major depressive disorder). I really don't know. Still, there are some pretty compelling reasons to taking advantage of psychotherapeutic counseling. If nothing else, it can help change the content of thought and thus reduce what I like to call "depressive pressure". To reduce depressive pressure can only help and not hurt. It can improve one's chances of responding to drug treatment and reduce the risk of relapse or medication breakthrough after a response is obtained.
>
>
> - ScottScott, this is interesting. And it did go over my head that therapy has not helped your depression. "Depressive pressure"--is that your own coinage? (I like it.) Hmmm. I have in mind my recent MBCT class which seeks to help one become aware of thoughts and sensations (and also examine & endure those that are categorized as 'painful'), and Southernsky's recent posts about the benefits of therapy for dealing with maladaptive behavior and TRD (now that's paraphrasing an eloquent set of posts!).
fb
Posted by Phillipa on November 22, 2009, at 19:24:50
In reply to Re: No benefit to adding psychotherapy to medicati » SLS, posted by floatingbridge on November 22, 2009, at 16:26:37
Here's that But word. It can only help if the therapist is compassionate, really listens to you and what you hope to accomplish, and helps you work out a plan of action. Didn't happen to or for me. And I'm tried so many. Phillipa on another note my three kids grown all no meds even blind Son and all have fabulous jobs and are happy. And I got divorced from their Father. I raised them alone as no support emotionally from him. I just said I will always stress their positive features never the negative. As my Mother was sick and screamed at me constantly as a child. Vowed to never ever do that to my kids?
Posted by morganator on November 23, 2009, at 1:45:12
In reply to Re: No benefit to adding psychotherapy to medication, posted by bleauberry on November 22, 2009, at 7:44:50
If you are working with a good therapist preferably with a PHD and psychodynamic therapy is taking place, simply making you feel good and comforting you is not the goal. You should not always feel comfortable. Therapy is hard and you have to do a lot of hard work to have success with it.
Posted by SLS on November 23, 2009, at 5:44:32
In reply to Re: No benefit to adding psychotherapy to medication, posted by morganator on November 23, 2009, at 1:45:12
> If you are working with a good therapist preferably with a PHD and psychodynamic therapy is taking place, simply making you feel good and comforting you is not the goal. You should not always feel comfortable. Therapy is hard and you have to do a lot of hard work to have success with it.
There have been times when, after a psychotherapy session (IPT), I felt as if I just finished a workout at the gym. Mental work is still physiological work. This even shows in a P.E.T. scan when one is asked to perform mental exercises.
- Scott
Posted by Meltingpot on November 23, 2009, at 6:03:16
In reply to Re: No benefit to adding psychotherapy to medicati, posted by SLS on November 22, 2009, at 16:05:50
I must say that I agree (for once) with Bleauberry here. I do believe that pscyhotherapy mainly works for people who are going through some kind of crisis.
I had therapy for months (along with lexapro) and the therapist I was seeing I really felt at ease with. We discussed my thoughts, my childhood, we had some mindfulness sessions and I even did some roleplay where I acted out being a child and then switched to my adult self comforting the child (if this makes sense), none of it helped or gave me any insight into why I feel the way I do today. I just don't see why dredging up the past would help, I didn't find it cathartic in any way.
Having said that It was nice to see somebody once a week just to offload about the meds not working and to blurt out all my worries and concerns about not getting better and I really did trust her.
At the end of the treatments, the conclusion by my therapist was that I was fixated on finding a medication treatment to work and I think the insinuation was that I was somehow subconsciously blocking anything else from working. She also recommended I took the Zyprexa a bit more regularly
Finally, my parents did divorce when I was 10 and I did experience some bullying at school so I guess I fit the model of somebody who would or should respond to therapy.
Denise
Posted by Meltingpot on November 23, 2009, at 6:05:28
In reply to Re: No benefit to adding psychotherapy to medication, posted by morganator on November 23, 2009, at 1:45:12
In what way is therapy hard? I didn't find it hard at all.
Denise
Posted by SLS on November 23, 2009, at 6:42:51
In reply to Re: No benefit to adding psychotherapy to medicati, posted by Meltingpot on November 23, 2009, at 6:03:16
Old post:
http://www.dr-bob.org/babble/20020416/msgs/103336.html
- Scott
Posted by SLS on November 23, 2009, at 6:53:46
In reply to Re: No benefit to adding psychotherapy to medicati, posted by SLS on November 23, 2009, at 6:42:51
Oops.
My post:
http://www.dr-bob.org/babble/20020416/msgs/103824.html
- Scott
Posted by floatingbridge on November 23, 2009, at 16:48:10
In reply to Sorry, posted by SLS on November 23, 2009, at 6:53:46
Scott, great repost--thank you.
Morganator,
After my session today, I am wiped out. For me, therapy is real work. So I guess I am an excellent candidate--and, may I add, I expect to be on meds indefinitely.
If psychiatrists and therapists--those working w/ biological, psychological, and emotional issues were as thoughtful and insightful (and kind) as Scott and others here, overall patient care would vastly improve and advance.
fb
Posted by bleauberry on November 23, 2009, at 18:51:23
In reply to Re: No benefit to adding psychotherapy to medicati » bleauberry, posted by floatingbridge on November 22, 2009, at 15:13:06
No prob. I had some rather startling powerful issues come up in psychotherapy. Things like losing a lover after spending 1/3rd of my life with that person, a childhood peppered with an alcoholic father, and a serious abandonment paranoia issue from the first 2 years of my life. None of these were the cause of my depression, but were nonetheless serious issues that needed to be brought out, disected, and strategies/tricks put into place to handle them.
That was 15 years ago. Unknown at the time, that first attack of depression was about 3 months after a tick bite and a strange flu that followed it. It took friggin 15 years for someone to put two and two together. I can't believe how doctors miss the obvious, but oh well, it happens thousands of times everyday. My guess is that better than 50% of the people here at pbabble are either misdiagnosed or underdiagnosed...all that is being seen is depressive symptoms.
So yes, I found psychotherapy very helpful, just not for the depression. In terms of depression, it was helpful to have a coach/cheerleader to keep my confidence up while waiting.
> > I did psychotherapy twice...weekly for 6 months each time.
> >
> > It was helpful but only for the half hour or so following the appointment. Ya know, a good counselor can lift your spirits, give confidence, get you relaxed and feeling better. The problem is, as soon as you leave, get in the car and start driving in the real world again, all of that evaporates real fast.
> >
> > I think the best uses of psychotherapy are:
> >
> > 1. When there is a definite life issue involved...divorce, death, loss of career, etc.
> >
> > 2. For pure biochemical depression without a life crisis component, I think psychotherapy serves a good purpose to help keep the patient on track while waiting for the medicine to hopefully kick in. It's almost kind of like having a cheerleading squad in your corner to send you back into the boxing ring each round with a renewed sense of confidence, hope, and patience. Without the counselor, we might abandon our meds too soon. They can help keep us on the path our doctor has chosen for us, or spot a situation where a doctor has made an obviously gross error.
>
> Bleauberry, I'm curious in the context of this discussion--I don't mean to pry--so take a pass on this if you want to. My understanding of your situation is that it derives from, primarily, lymes disease (I could very well be mistaken). Maybe you do not have very much trauma (or life/situational) distress to process? And therefore, maybe not too much maladaptive behavior/cognition?
>
> Best regards,
>
> fb
>
>
Posted by morganator on November 23, 2009, at 23:41:43
In reply to Re: No benefit to adding psychotherapy to medicati, posted by bleauberry on November 23, 2009, at 18:51:23
Depression can also linger underneath layers of denial and other mechanisms of coping for years. We may be angry or depressed/sad about something deep inside but not really feel it. This is why when therapy is really working people get depressed before they get better. As you work through emotions that you have been carrying deep inside for so long you have to feel them and fully experience them in order to work them out of you. This may take some time. Many people are unwilling to do deal with the pain they carry which is why therapy is not successful.
Not only should one be working hard in during the therapy session, but one should be working hard outside of therapy in between session. This takes lots of reflection and time spent trying to work out what it is that ails your psyche.
I feel like most people, even the most and maybe especially the most intelligent people, do not want to think about how powerful our psyche is and how crucial it is that we have the proper nurture while developing. I believe that many of us need medication at this point in our lives but I also think that many of us taking medication would benefit from several different types of therapy, including psychodynamic and psychodynamic group therapy. There is a part of me that believes that despite our genetic predisposition(which I think is exactly that, a predisposition) we may not have needed medication in a different world.
I would like everyone to consider going to group psychodynamic therapy. I think it can work wonders, especially if two highly qualified and well trained psychotherapists conducted it. If you want to go further than what your medication can take you, you would at least try group therapy for a few months. You also have to be willing to face yourself like never before and do some serious heavy lifting.
Posted by floatingbridge on November 24, 2009, at 0:04:05
In reply to Re: No benefit to adding psychotherapy to medicati, posted by bleauberry on November 23, 2009, at 18:51:23
Thank you, Bleauberry, for your post. I'm sorry you had to wait so long to reach bedrock. 15 years is a long time to endure--and to delay treatment for Lymes. Since I asked, I thought I'd share, too.
Childhood deprivation, (sadly not uncommon), figures largely in my illness, followed by a traumatic transition into adulthood. After awhile, I think I just broke down, no longer able to compensate. The more I read about c-ptsd and ptsd, the more my life-long 'malfunctions' make sense (inability to sleep, to self-regulate, dysthymia, mood swings). Depression seems to be my only baseline. And, as far as I can see, mental illness 'runs' in my family. Nature, nurture, the whole enchilada. Who or how I would have been in a happier, healthier family is moot--actually it's a self I have to imagine and construct. For me, effective therapy is vital.
This entire thread, and a few others running concurrently, have me reconsidering the weight I've always given therapeutic intervention. No big 'click' experience yet--I am realizing how little I know about other's experience of mood disorders in all its' variants--the why, the how--just how little I really know.
peace, and all the best to you,
fb
> No prob. I had some rather startling powerful issues come up in psychotherapy. Things like losing a lover after spending 1/3rd of my life with that person, a childhood peppered with an alcoholic father, and a serious abandonment paranoia issue from the first 2 years of my life. None of these were the cause of my depression, but were nonetheless serious issues that needed to be brought out, disected, and strategies/tricks put into place to handle them.
>
> That was 15 years ago. Unknown at the time, that first attack of depression was about 3 months after a tick bite and a strange flu that followed it. It took friggin 15 years for someone to put two and two together. I can't believe how doctors miss the obvious, but oh well, it happens thousands of times everyday. My guess is that better than 50% of the people here at pbabble are either misdiagnosed or underdiagnosed...all that is being seen is depressive symptoms.
>
> So yes, I found psychotherapy very helpful, just not for the depression. In terms of depression, it was helpful to have a coach/cheerleader to keep my confidence up while waiting.
>
Posted by floatingbridge on November 24, 2009, at 0:07:28
In reply to Re: No benefit to adding psychotherapy to medicati, posted by morganator on November 23, 2009, at 23:41:43
Morganator, what is group psychodynamic therapy? Like, how are sessions conducted?
fb
Posted by morganator on November 24, 2009, at 0:49:54
In reply to Re: No benefit to adding psychotherapy to medicati » morganator, posted by floatingbridge on November 24, 2009, at 0:07:28
The one I was in and hope to get back into(the only reason why I stopped is because I moved away for a short while) had my therapist and another therapist that she worked closely with in her practice. The room would be set up with all of the chairs in an oval, as if everyone was sitting down for dinner without the table. Each therapist would be positioned at each end of the oval, like the heads of the table. Ideally you want a female and male for therapists as they act as mother and fathers figures.
The goal of group is to not just have another approach to getting to the bottom of and working out issues, but most importantly to learn to better love yourself and better be able to form and maintain positive relationships. Learning how to get the best out of yourself and others through proper communication is the main point of group therapy, at least the one that I was in. You find yourself learning so much about who you are and how you can improve your life through communicating with members in group. The therapists are there to guide and help resolve conflicts. They give input much like they would give in individual therapy. The therapists want everyone in group to form a strong bond. They do not want members to team up and sub group. Communication outside of group, while members are still involved, is heavily frowned upon. And, if you do happen to run into someone outside of group you are supposed to mention it in the next session. I guess talking outside of group can jeopordize all of the work being done inside group.
I think it is a wonderful experience if you are willing to put yourself out there and work hard. My therapist always said that if you come to group and never feel anxious than you are probably not getting out of it what you should be. If you don't feel anxiety than you are not being challenged. A good group should not make you feel pressured to talk. You should feel like you can go at your own pace. Although some group members may express that you are cheating yourself and others in the group by not talking and participating enough.
Group therapy is something I think everyone, even those that are not suffering, would benefit from. Not all groups are the same so everything I described here may not apply to all therapy groups.
Posted by SLS on November 24, 2009, at 6:09:37
In reply to + w/ a comment to morganator Re: Sorry » SLS, posted by floatingbridge on November 23, 2009, at 16:48:10
There are probably as many different types of depression as there are people. What I mean by this is that each person has a unique neurobiological constitution and a unique psyche. I therefore cannot subscribe to the notion that one size fits all. Again, I prefer to describe the etiologies and treatments of different depressions as lying along a spectrum. To say that everyone with depression will respond to psychotherapy is as ivalid as saying that everyone with depression will respond to an antidepressant.
At present, I believe that true major depressive disorder and bipolar disorder are predominantly biologically-driven illnesses that do not respond well to psychotherapy. The place that psychotherapy has in these illnesses is debatable, but an individual often makes little or no progress with it until the abnormal biology is treated successfully.
The dynamics between biology and psychology as they interact in an individual with depression are quite complex. It is a gestalt.
- Scott
Posted by Iansf on November 24, 2009, at 12:47:17
In reply to Re: No benefit to adding psychotherapy to medicati, posted by morganator on November 23, 2009, at 23:41:43
While I agree agree depression can linger underneath layers of denial, I do not believe this is true of the typical person suffering from chronic depression. It is perhaps common among "overachievers" but not common among the population in general. For both myself and most people I've known who suffer from long-term depression, the depression is anything but hidden.
I do not accept the notion that it is helpful to force a person in pain to go into even more pain. From my own experience and my observations of others, what most depressed people need to do is find a way to alleviate pain, not to suffer more. To my mind, there is something sadistic about pushing people deeper into pain as a pretext for therapy. Living in long-term pain is profoundly disempowering. What I gained from antidepressants is a recognition that life can be pleasurable, and that provided me a foundation I could build on. Years of psychotherapy did nothing in that regard.
Also, I've found it extremely common for psychotherapists to claim their patients aren't working hard enough if their methods are not working. I find that very arrogant. Perhaps they should take a look at whether they themselves are not working hard enough, or, from a more charitable viewpoint, ask if perhaps the techniques they use are either inadequate in general or inappropriate for the particular client. Few other professions can get away with blaming the client for the failure of their methods.
> Depression can also linger underneath layers of denial and other mechanisms of coping for years. We may be angry or depressed/sad about something deep inside but not really feel it. This is why when therapy is really working people get depressed before they get better. As you work through emotions that you have been carrying deep inside for so long you have to feel them and fully experience them in order to work them out of you. This may take some time. Many people are unwilling to do deal with the pain they carry which is why therapy is not successful.
>
> Not only should one be working hard in during the therapy session, but one should be working hard outside of therapy in between session. This takes lots of reflection and time spent trying to work out what it is that ails your psyche.
>
> I feel like most people, even the most and maybe especially the most intelligent people, do not want to think about how powerful our psyche is and how crucial it is that we have the proper nurture while developing. I believe that many of us need medication at this point in our lives but I also think that many of us taking medication would benefit from several different types of therapy, including psychodynamic and psychodynamic group therapy. There is a part of me that believes that despite our genetic predisposition(which I think is exactly that, a predisposition) we may not have needed medication in a different world.
>
> I would like everyone to consider going to group psychodynamic therapy. I think it can work wonders, especially if two highly qualified and well trained psychotherapists conducted it. If you want to go further than what your medication can take you, you would at least try group therapy for a few months. You also have to be willing to face yourself like never before and do some serious heavy lifting.
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Dr. Bob is Robert Hsiung, MD,
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