Evaluating your own treatment
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Evaluating your own treatment

Q: I see a psychoanalytic psychiatrist 1-2 times per week for the past 10 months, since my spouse unexpectedly died. My moods were wild beforehand and the past year has been hell. Until recently, my doctor had been unwilling to put me on medication. I feel terrible, how does one know whether the treatment course one is engaged in is appropriate? I have a lot of time and dollars invested in this endeavor==I know that there is considerable difficulty involved in separating the grief issues from any underlying biological problem. But how much patience is required? I'm not certain anything is going to help, and my family is certainly suffering in the interim. M.

Dear M' --
I'd better be careful here or someone will think I'm anti-therapy.  I'm very pro-therapy: more than half my patients are doing therapy with me as well as medication approaches.  I'm not very pro-psychoanalytic psychotherapy, at least not for symptoms; for exploring one's own psyche, there may be some benefit -- at least a lot of people seem to think so (on the other hand, after paying that much money and spending that much time, it would be pretty tough to think otherwise; and if you did, would you admit it to many people?)

There I go, you see.  At any rate, there are good therapies with solid evidence that they "work" -- ie. better than being on a wait list, and as well as medications.  Those therapies include, so far, "cognitive behavioral therapy" and "interpersonal therapy".  So if you're actually really hurting and you need a therapy that will do something for symptoms, CBT or IPT might have more to offer than what you're doing.  However, your current therapist should be given a chance to comment on that before you bail.  She or he might actually do CBT. 

To answer your good question -- "how does one know whether the treatment course one is engaged in is appropriate?":   very hard for a person in your position to tell.  I try to tell my clients what to expect and what the alternative approaches are, as we go along; but that kind of discussion has never been part of psychoanalytic approaches -- it would be too "active" on the therapist's part; and, to be a bit more gracious, it would therefore potentially interfere with the way that therapy is supposed to work. 

So for now, what you do is educate yourself about what options you have, and ask aloud about them.  If you don't get a reasonable answer, consider moving on

Dr. Phelps

Published December, 2000

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