I recently read an interview with Alan Kazdin, a Yale psychologists who argues that as a service delivery model, individual-based psychotherapy is essentially mistaken. I've linked to the interview and provided the title of the actual article as well (if you can't get it, pm me and I send it to you). I am bit a conflicted in on this topic as I agree largely with Kazdin that despite having enormous evidence of what works and how to help people, the main problem is the fact that most of the people that needs these services do not receive them. Moreover, the individual based psychotherapy model appears to be too limited in scope and perhaps larger, mutli-dimensionsal, and longitudinal efforts (even in non-traditional settings and service providers) are needed. However, I still can't get away from the fact that I believe individual psychotherapy will always be needed, despite the fact that it's not the best way to reach a large number of people. I think it still provides a certain niche market of people that may be missed by broader efforts.

Anyways, I wanted to see what everyone else here thinks about this issue.

http://healthland.time.com/2011/09/13/q ... hotherapy/

Article Title: "Rebooting psychotherapy research and practice to reduce the burden of mental illness." In "Perspective on Psychological Science"

Half the mental illnesses in the United states are related to drugs and alcohol. The other half is related to genetics, injury, defects, poverty, and abuse. Wouldn't it be smarter to educate people about drugs and alcohol and provide genetic counselling than to treat the disease after the fact?

This may be a poor analogy, but it's like inviting people to go for a late night swim, then in the morning finding all the dead and dying bodies at the bottom of the pool because someone forgot to add water.

There's a massive effort to reach people with psychotherapy. Just look at the self-help section of any book store.

The big problem, IMO, is that the 'System' doesn't want large numbers of independent, self-connected thinkers. It would make propaganda less effective and large numbers of people more difficult to control. Better to have fearful, dependent, obedient automatons. They're much more predictable and easier to sway whichever direction you like.

It would be simple to 'give away' psychotherapy, if you wanted to. Teaching children about their minds, how they work, their needs and how to connect to them & other's, negotiation, resolving conflict and developing introspective habits could easily be added to school classes.

Psychotherapy and psychiatry is quackery if you ask me. Psychiatrists don't do lab work, EEG's, Cat Scans, X-rays, endocrine studies, hormone studies, or even neurological exams. They rely on talk and listening therapies -- insane! People are known to lie, exaggerate, forget, and withhold information. How can a therapist help people with those kinds of variables? They can't! That's why the failure rate is so high.

People are going to have to demand better from the psychiatric community. They are going to have to demand lab tests and other state of the art medicine in order to make lives better for people who are suffering.

I know for a fact that Europe is light years ahead of the United States when it comes to treating people with depression.

Patient! Heal thy self.

I know for a fact that Europe is light years ahead of the United States when it comes to treating people with depression

Really? How wonderful! I'm serious. I've suffered from unipolar depression on-and-off for over 40 years. (currently stable) I'd be most grateful if you could outline some specific ways Europe is so far ahead of us.

My own views; Not sure whats is meant by 'traditional'. I was unaware there is just one model.Here in Australia, the majority of psychiatrists are prescribing Freudians. Some are only psychotherapists, which I consider largely bourgeois self indulgence. Freud's model of consciousness we so blithely accept (Id, Ego,Superego) has no empirical base.


Here anyone can call themselves a therapist,I'm familiar with several models: EG Behaviouralism (my favourite: works for ME) Transactional Analysis, Neo Rechian Psychology (Radix) Rational Emotive Therapy, Reality Therapy and Gestalt.

My observation is that every one of those approaches will work for at least some people in the short term ,that none work for everyone and that few are successful models for permanent change.

Is it ALL bullshit? I don't believe so; I DO believe that without antidepressants, I would probably have killed myself over 30 years ago.

Imza wrote: Moreover, the individual based psychotherapy model appears to be too limited in scope and perhaps larger, mutli-dimensionsal, and longitudinal efforts (even in non-traditional settings and service providers) are needed. However, I still can't get away from the fact that I believe individual psychotherapy will always be needed, despite the fact that it's not the best way to reach a large number of people. I think it still provides a certain niche market of people that may be missed by broader efforts.

I don't think that broadening the range of interventions as suggested by Kazdin in his article (Internet, Telephone, smartphones...) means that the traditional psychotherapy model is mistaken. To me it is just an extension of it. I, personnally, think that the problems that suffers traditional one-on-one psychotherapy will be the same for other methods of delivery, such as suggested by Kazdin. I think that first people need to be more educated regarding how to choose the model of intervention, ie which is evidence-based practice and which is not. The medium of intervention (psychotherapy, self help book, internet...) seems to be a secondary issue to me. Althought it would be of great advange to broaden access to prevention and treatment, I would say that without knowing how to navigate into all that is offered, one can end up with reading a book about vitamin-C diet to "cure" a depression (I am obviously exaggerating here ). The same goes for parenting prevention program I think.
I am not sure this is anwering your question, though. Here, in France, there is not so much nationwide policy in regard to help people assess what to choose as a model of psychotherapy, so maybe that is why I think efforts should be put on this mainly.

gleniedee wrote: "I DO believe that without antidepressants, I would probably have killed myself over 30 years ago."

But you have to realize that psychiatrists don't know how most antidepressants work. I don't have depression, but if I did, I would never put a chemical in my system that might screw up my brain even more, or interfere with how neurotransmitters work in my body.

People who naturally make too much oxytocin (not Oxycontin) are overly friendly, overly trusting, and become easy targets for abuse by people who ordinarily have no criminal background. People who don't make enough Oxytocin experience stress, become obese, develop psychotic behavior, impaired cognitive function, and depression. WHY CAN'T WE MEASURE THIS? (Sorry, I didn't mean to shout. I'm just so frustrated by the suffering of the mentally ill and there seems to be no real lasting help for these people.) Why can't we establish the normal levels for neurotranspmitters as easily as we establish normal levels for a CBC or a UA? DON'T TELL ME IT'S TOO EXPENSIVE! Rubbish! Mental illness is horribly expensive in relation to non productivity, harm done to family and communities, let alone failed treatment.

Mental health is about 150 years behind the times. It's time for a change. It's time for some REAL medicine for the mind, with REAL results that people can actually experience.
_____________________________________________________________________________________________
Let's suppose...
0= concern; 10= optimal mental health

Here are my (assumed) numbers:
Serotonin 3; dopamine 7; norepinephrine 5; oxytocin 6; endorphins 6; cortisol 7; acetylcholine 5, ATP 5

These numbers would show the doctor that I'm getting my sleep, I'm exercising, eating well, and having a good romp in the boudoir occasionally. But he would voice concern for the serotonin level being a bit low. He would ask me if I was defensive and unwilling to take risks. I would say he is correct, but I like myself that way. No prescription would be advised and we would visit this area of concern later if it becomes a problem, and then I could CHOOSE to take a serotonin reuptake inhibitor or not.

To me, this is how mental health should work, but it doesn't. It borders on WOO... or good vs evil-- unacceptable!
_____________________________________________________________________________________________
Sources:
1. The Mind Wide Open by Steven Johnson
2. The End of Stress as We Know It by McEwen/Lasley

Grace, now calm down now...

chairman bill, and what do you base that on?

Grace wrote:Psychotherapy and psychiatry is quackery if you ask me. Psychiatrists don't do lab work, EEG's, Cat Scans, X-rays, endocrine studies, hormone studies, or even neurological exams.

Not where I'm from. The best one's work with the patient's GPs and necessary specialists. They work as a team conferring with each other on findings. I know this first hand.

felltoearth, I know that other countries are light years ahead of the United States. You should be proud of Canada, a country for the people, not corporations.

chairman bill wrote: "Base what on?"

"there will be considerable variation, and messing about in rough & ready manner might cause as much problem as it ever solves."

What do you base this assumption on?

HELLO???

Grace wrote:Half the mental illnesses in the United states are related to drugs and alcohol. The other half is related to genetics, injury, defects, poverty, and abuse.

Grace wrote:The other half is related to genetics, injury, defects, poverty, and abuse.

the way you divide them up is mixing apples and oranges. while everyone will disagree on the statastics, mental illness is most definitely divided into 2 categories:

environmental (or as you said, "related to drugs and alcohol. The other half is related to, poverty, and abuse.")
physiological (or as you said, "genetics, defects, injury" brain injury - severe enough leading to changed physiology")

in modern medicine (in first class countries) there are two categories of physicians associated with this:
1. those who treat environmental issues - psychiatrists
2. those who treat physiological issues - neurologists

*which is not to say one will not dabble into the other class from time to time, which leads to the problem


the line becomes blurry in 2 instances:
1. when environmental issues become so influential they change the way the brain works (example: childhood abuse leading to changed emphases on the limbic system)
2. when physiological issues are so subtle that they are treated as psychiatric (example: in SOME cases - depression, anxiety)


adapting to the blurry line is the current issue with the psychotherapy model. nobody is ahead of anyone on the matter because the technology is not out for receptor treatments (instance 2 of the blurry line) or medications/surgeries that can miraculously change the way an individual thinks - a process which literally took a lifetime to figure out (instance 1 of the blurry line).

Grace wrote:chairman bill wrote: "Base what on?"

"there will be considerable variation, and messing about in rough & ready manner might cause as much problem as it ever solves."

What do you base this assumption on?

it is known that neurotransmitters and neural hormones differ in rough concentration from individual to individual, and even in rough ratio. hell, even neuron levels differ person to person, glial cell levels, and neuron:glial cell ratio. literature on that is ancient (neuron/glial cell work is newer though), you can pretty much pick up any neurophys book and it will tell you this.

Grace wrote:People who naturally make too much oxytocin (not Oxycontin) are overly friendly, overly trusting, and become easy targets for abuse by people who ordinarily have no criminal background. People who don't make enough Oxytocin experience stress, become obese, develop psychotic behavior, impaired cognitive function, and depression. WHY CAN'T WE MEASURE THIS? (Sorry, I didn't mean to shout. I'm just so frustrated by the suffering of the mentally ill and there seems to be no real lasting help for these people.) Why can't we establish the normal levels for neurotranspmitters as easily as we establish normal levels for a CBC or a UA? DON'T TELL ME IT'S TOO EXPENSIVE! Rubbish! Mental illness is horribly expensive in relation to non productivity, harm done to family and communities, let alone failed treatment.

Mental health is about 150 years behind the times. It's time for a change. It's time for some REAL medicine for the mind, with REAL results that people can actually experience.

This would be great, but there are problems. The problems are an individual would need to get their levels tested periodically from birth (depending on the age of the patient so that some baseline can be established) to determine what is currently going on in their life. This is because there is no designated "this is a normal level and that is an abnormal level". It's completely individualized, and worse - it changes within the individual on a very frequent basis. You might be upset for an hour before your blood draw and your neurotransmitter/neural hormone levels would come back completely different. Then what do you do? Repeat the test because they displayed an anomaly? How much variation should even be considered an anomaly? What if the patient just tells you they were upset and the blood work comes back as it normally does, should it be retested to match their current predicament? I hope you see where I am going with this.

It may be behind it's time. But until there is primary care allowed to every citizen in the country, and until they are able to individualize it to the extent that baseline levels can be determined, what you said won't be able to be put in practice.

felltoearth wrote:

Grace wrote:Psychotherapy and psychiatry is quackery if you ask me. Psychiatrists don't do lab work, EEG's, Cat Scans, X-rays, endocrine studies, hormone studies, or even neurological exams.

Not where I'm from. The best one's work with the patient's GPs and necessary specialists. They work as a team conferring with each other on findings. I know this first hand.

Same is true for me. And my psychiatrist orders a lot of the lab work himself. Regularly. He may be unusual in this regard, but often I find him better informed and more current with recent findings than other specialists in their own fields. And he works quite closely with my psychologist, too (with whom I do talk therapy).

Count me amongst those who can say that their lives have been literally saved by a combination of drugs and talk therapy.

By the way, just because they don't know everything about how psychiatric drugs work now does not mean it will always be thus. As a science, it's early days. We're finding out more all the time. And even speaking of the present moment, it's not true that we know nothing. There is a spectrum among the pharmacopeia. And we understand some drugs very well indeed.