Psychotherapy: The Active Treatment
My friend Anne and I were talking the other day when the conversation turned to a recent airplane flight she was on. She recounted how it was on one of those smaller, turboprop planes with just 3 seats per row:
“We hit some turbulence and then it was like we were free-falling. It was only a few seconds, but it was the scariest moment in my life. I felt so helpless and out of control. I know it was irrational to think anything bad would happen, but still …”
When a person isn’t in control of his or her own destiny, most people feel powerless. Powerlessness can lead to feelings of helplessness as well. Most people prefer to be able to exert some influence on their destiny, on their future. We’d like to think that we actually have something to do with the way our life turns out, don’t we?
So why are so many people seemingly so willing to give up their power when it comes to treating their own mental health condition?
When you have a mental health condition — such as depression, anxiety, attention deficit disorder, bipolar disorder, or something else — you have one of four choices:
- Do nothing — sometimes time alone will take care of these things
- Get treatment with medications
- Get treatment with psychotherapy
- Get treatment with both medications and psychotherapy
That’s what it boils down to. Who you go to in order to receive treatment is a secondary issue (although the data show that most people turn to their primary care doctor first).
We know from experience that most people choose one or two. In fact, psychotherapy has witnessed a decline in usage over the past few years. We don’t know why, exactly, but it corresponds nicely with a rise in people taking psychiatric medications.
People who go down the psychiatric medications road without trying psychotherapy first (or at least at the same time) are doing a great disservice to themselves. They are accepting a passive treatment over an active one, and not only that, but a passive one that will nearly always result in initial failure.
Treatment of Depression with Medication
Let’s look at depression as an example. Depression is a great disorder to examine for treatment, because there are just so darned many antidepressant medications available to help treat it, as well as a wide variety of effective psychotherapy techniques.
We know from studies such as the large government-led STAR*D research that nearly two-thirds of people who try an antidepressant won’t get a therapeutic result from it. This is not surprising, because physicians and psychiatrists use nothing more scientific that trial and error to choose from among the nearly two dozen antidepressants they can prescribe. In other words, once you’ve been medically cleared by your primary care physician, there’s a chance we could probably train a gorilla to randomly choose an antidepressant that would be as effective as one chosen for you by a trained professional.
After trying two different antidepressants, about half of people who are taking them will feel a positive impact from their use. After trying four antidepressants, that number goes up to 70 percent. However, more and more people drop out of treatment the more antidepressants you try on them. This is not surprising — people don’t like to be treated like guinea pigs. They actually thought there was some science behind antidepressants, when the truth turns out to be that the science just isn’t that helpful in making clinical treatment decisions.
All the while, the patient is a passive observer to the process. They agree with the doctor because they’re not really given that much of a choice. Even if you knew all the psychiatrist knows about antidepressants, it still would do little to help inform your decision-making process (unless you knew you definitely wanted to continue having sex, then you could simply avoid all of the SSRIs).
Take the pill at the prescribed time. Wait. Rinse. Repeat.
Psychotherapy Requires Active Participation
Compare that process to the process of psychotherapy. In psychotherapy — no matter in what form it’s practiced — you have to be an active, engaged participant (not unlike participatory medicine). This means working hard every week on change, on discovering the negative thoughts and behaviors you want to break free from, and making the changes necessary to help you move forward.
You will also have an active, engaged professional helping you along the way. They will be your mentor and cheerleader in the process, and ensure that even when you get “stuck,” they find ways to help you get unstuck.
Good psychotherapy isn’t simply recounting what’s happened to you since your last visit, or how you’ve felt in the past week or month. Although that can be a small component of each weekly visit, it should never be the focus. The focus is in helping you better understand your thoughts, relationships and behaviors, and how all of that impacts your emotions and can lead you into whatever condition you’re grappling with.
It’s Not Either/Or — It’s Both!
Inevitably, somebody will glance through this article, not really reading it, and will walk away thinking that I’m somehow putting down psychiatric medications. So let’s be clear on that point — I acknowledge and believe that psychiatric medications have helped millions of people who otherwise may have not found relief for a serious mental disorder. They play an important role in the treatment arsenal available to professionals and patients today.
But for most people — according to the research anyway — they do not play a good role when they are used solo.
Psychiatric medications are a passive treatment that require little activity on the part of the patient (and the activity it does require is mindless — taking a daily or twice daily pill). Psychotherapy — when done right — is an active treatment that requires a lot of activity on the part of the patient. You change yourself, with a therapist helping to guide you in that change.
I believe that for most people grappling with a serious mental disorder, both types of treatment are usually necessary to effect long-lasting and substantial change. Of course, there are exceptions to this, and folks who have been grappling with their bipolar disorder or schizophrenia for decades may believe that therapy has little to offer them (which indeed may be the case).
Psychotherapy: The Active Treatment. Now where do we get a marketing campaign started to help educate and inform consumers about this invaluable treatment option?
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Grohol, J. (2010). Psychotherapy: The Active Treatment. Psych Central. Retrieved on March 31, 2015, from http://psychcentral.com/blog/archives/2010/03/26/psychotherapy-the-active-treatment/