Good article on psychotherapy in the NYT magazine

About 25 years ago I changed professions. I had been a psychotherapist in a large urban mental health center. I saw myself as a therapist but more and more, drugs were the preferred method of treatment and I was there to provide support to the physicians who wrote scripts.

Financial issues played a role as well and I decided to become a teacher. That turned out well, very well, but I’ve never lost my interest in working with myself and with other people to achieve a better life. Some years after leaving the field of psychotherapy, I went to a party where I ran into some people I had worked with. They said the field was then almost entirely turned over to medications.

One thing, besides the increasing role of medications and the financial instability of mental health work, that moved me away from that field was my own growing awareness of the existential and spiritual elements of psychotherapy. Most of my clients were poor, uneducated people who supposedly could not benefit from so-called “talk therapy”. However, I found that both with them and with the few highly verbal and sophisticated clients I saw, their lives boiled down to choices. I realized that most of the psychiatrists I saw did not see these clients, their patients, this way.

So reading an article just now in the NYT magazine (April 24, 2010) on how a psychiatrist shifted from making diagnoses and prescribing drugs to getting to know his patients, bolstered my own sense that I had been on the right track to leave the field. I left just as the pressures of insurance companies and medical/psychiatric practice were pushing psychotherapy into the background.

This psychiatrist, the author of the article, uses medications where appropriate, which is a far cry from the statement made by a psychiatrist who was interviewing me for a possible position in his office: “Whoever walks in the door gets an immediate prescription for Mellaril [a powerful psychotropic drug)”. No interview, no knowledge of the patient, just pop a pill and turn them over to the social worker for a mental status exam and social history.

My guess is that eventually the author of the article will find that as he gets into the lives of his patients, he is going to find that he runs up against the issues that fascinated me about working with people. They are human issues and, while some of us have disorders that can be ameliorated by drugs (the example of the 40 year old woman who benefitted immensely from Ritalin due to a previously undiagnosed attention deficit disorder), he will find that he and his patients will have to wrestle with age-old problems that will lead him to referrals to spiritual healers like priests and pastors and rabbis and mullahs, not to mention Ayuravedic practioners, accupuncturists, massage therapists, etc.

One of the last major pushes I made in the clinic I worked in and retreated from was to form, with a client highly trained in martial arts, a children’s karate group. As time wore on, it became usual in that clinic for all the therapists to refer children to that group. If we can ever get back to the idea of community, that it takes a village to raise a child, we can give drugs to those who can benefit from psychopharmacology but introduce others to a more balanced way of life and thought. After ruling out organic brain disorders and biochemical disorders, we can help people find a better way of life. And if a drug will help them sleep or calm them down in the process, that’s fine.

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