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the rewards and short comings of talk therapy

I loved this week’s selection of reads…Such a cry from the DSM 5 attitude toward the not so normal which sometimes, though painfully so, ends up being an enrichment to our lives as Longden affirms at the end of her talk. Of course being tortured by a voice, which becomes a cohort if you don’t listen to it in the short term is not the same as mind chatter. To see people in the throes of mental anguish is not the same as talking about it from the safety of our computers. The shift to over drugging patients over the last 40 to 50 years, I think was as much ̶ sometimes ̶ to placate the anguish of the therapist as they watched people suffer who they could not reach back before there was any effective psychopharmacology. I remember my brother a clinical psychology talking about the grief work he had undertaken to help his psychiatric hospital team in Tennessee as they slowly and powerlessly watched a patient pick himself to death with his fingers over the course of a few years regardless of the interventions they tried. A little part of them died when he did.
Still I do think it is about time we find a middle ground between talking therapy and pharma therapy. But first we will have to convince manage care to change its ways. I watched a very successful psych hospital back in the late 80s early 90s get ground down by short term expectations of managed care. Going from a long term, talking-care, team approach, facility, to a private hospital whose patient list dwindled to suicidal patients and small children all of whom also suffered from suicidal tendencies ̶ allowed only to offer a short term medicated approach for emotional pain, and where the therapist primary function got regulated to arguing for patient days with manage care and discharge planning. It doesn’t leave a lot of time for talk therapy.
Personally I have been blessed over the years with access to a variety of psychological modalities’. Training in the medical model of therapy and a number of modalities similar to those talked about by the various people we listened to this week. For me the one that help me to achieve the greatest peace of mind from conflicting inner dialogues, if not voices, is Roberto Assigoli’s Psychosyntesis (http://synthesiscenter.org/ps.htm or http://www.psychosynthesiseastwest.com/) which contains many of the meditative idea talked about by Rufus May.

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2 Responses to the rewards and short comings of talk therapy

  1. I agree the idea of a middle ground is important between medication use and taking advantage of therapy (talk, behavioral, etc.), and that these pieces we’ve read and watched this week give a strong voice to the non-pharma side when it comes to hearing voices. These discussions surely need to take into account, though, that these things (affects, medication, therapy) each have their spectrum and when combined also fall on an overarching spectrum which then fluctuates at any given time. I think Yael’s acquaintance who is capable of adapting and adjusting in terms of self-medicating, and able to look out for her own best interests without assistance, is an informative account. But what happens if someone worsens and can’t help themselves adjust in order to adapt? What about in severe cases where people aren’t able to help themselves for lengths of time, worsen, and even infringe on the health and safety of others? What about the economic side of these modalities?

    When someone isn’t able to administer self-care and/or needs access to outside services, economics becomes a part of the web. Across the spectrum, how does someone get medication? Therapy? Managed care? Who is paying for it, especially when not the individual? What costs less in the current system? I assume a drugs-only approach costs less in the system as it is right now, but a drug-therapy approach or rigorous therapy-only approach might surely benefit individuals and society more over time and in terms of overall health (mental, physical, social, economic). Anything that can be done to turn the tide (from where we are now to awareness to action) would be exciting.

    Overall, though, I was really interested in this week’s pieces, as they put in front of me some things I hadn’t thought about before… especially Rufus May’s video. Such a head-on, forward approach. I was particularly struck by the end where he discusses addressing the parts of individuals, as I know this type of approach from psychotherapy work I’ve read about, on subpersonalities, called Internal Family Systems.

  2. I agree that there should be a medium. I know someone who seeks talk therapy from one source and prescriptions from another. The talk – therapy, as well as exercises she performs herself, and life stressors, help decide her dosage of medication. Her case is different as she has General Anxiety Disorder and not a hallucinatory diagnoses. However, the day by day method is useful because she determines how much she can handle before feeling overwhelmed. Unfortunately, as I fear may be the case for many others, she often feels the need to push through her overwhelming anxiety. She feels that she loses by taking the medication and that if she were stronger, she could use her mind (I think Ayana’s video mentioned that) to overcome the stressors. The medication is there to help increase her levels of serotonin and put her on an even playing field with those whose bodies already produce the amount needed for non-anxious processing. However, she sees it as a weakness in herself.

    I’m not sure what the moral of the story is. I do believe in medication but I believe each individual should have the opportunity to explore the options available to them and find the right fit/combination.

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