Psychiatists. ( Archived) (13)

Thanks, all. I'll respond without focus on any one comment. There is a small percentage of these docs who can provide help to folks who do, or think, they need such "help". Which brings up issue #1. The good ones will spot those who really might benefit from the craft in a few sessions, and will then contract to treat. If not, will refer, or counsel not to seek treatment, accordingly. Problems may be more spiritual, existential, circumstantial, familial, developmental, neurologic, and so on. The counterpoint to this is the issue of matching client and treator. A few sessions should be spent exploring this, and in the apparent absence of such, a real professional will do the above, perhaps to someone better matched. #2. Plenty of evidence shows, with possible few exceptions, that the actual tradition of therapy is far less important than the trust and relationship between folks in the clinical dyad. #3. Similarly, some approaches have finally, thankfully, mostly fallen by the wayside---see my quote of Freud above. We no longer bleed the sick, with rare exceptions. #4. For the longest time, programs to train these docs have had little in the way of systematic competency based education in the likely most effective treatments. Now there are six such exposures. The days of "whatever goes" seem over. #5. Yes, the implication that such a choice of medical specialization is not without selective pressures based on one's own issues rings true. Years ago, when the majority of trainees gravitated to Freudian traditions, a so called training analysis was de rigeur. Good thinking, but little evidence of efficacy, as anyone can see by viewing the field and its practioners. #6. The medicines used have their places, but are quite dirty in terms of adverse effects, and few really are anything new. Also, there is much over prescribing and mis prescribing, reflecting in part the increase in novel non physician prescribers, and the push toward 20 minute evaluations. Marketing by big pharma plays its part here as well, as does the enormous "placebo" effect in medication research. #7. Relatedly, who doubts that the primary seat of behavior and emotions, the brain, is infinitely more complex than even, say, such highly complex organ systems as the immune system, etc. Research in the field only recently has shown more humility in recognizing this, and was thinking far too narrowly/rigidly, and ignoring important other human factors as listed in #1 above. #8. Similarly, the field had arrogantly ignored other healing traditions, many of which have much to say. For example, if a dozen patients with "rigorously diagnosed" major depression were to present to a practitioner of, say, traditional Chinese medicine, with experience in acupuncture/acupressure/herbalism---various diagnoses, and different treatments might be considered/offeredd. #9. Research in the long term sequelae of ACE's (adverse childhood experiences), esp. at ages before formed memories, need more emphasis, and not only for emotional, but for "physical" issues as well. #10. The best such docs are likely those with added training in childhood, family and developmental traditions. Duh! Lots more here, but this ought to get the juices flowing. Aa-V-A.