Serious Problems in Psychotherapy Require Serious Medicine
As a patient in psychotherapy, do you wonder whether the work you and your therapist are doing will succeed and produce lasting results? You may like, even admire, your psychotherapist, but how do you know that as a result of his or her work you will achieve the goals for which you came to treatment?
Patients frequently remain in the dark about whether treatment is actually succeeding. The solution to this dilemma is a treatment considerably broader in scope than conventional psychological and psychiatric therapy. This treatment embodies proven techniques for accurately assessing the nature and severity of a psychological problem and for monitoring treatment progress. In using these methods, therapist and patient work collaboratively to track progress, continually providing feedback to each other.
In conducting this innovative method of treatment, the therapist assumes the kind of clinical responsibility that is typical of a physician. He or she takes responsibility for addressing the full range of the patient’s presenting and underlying problems, and coordinating his or her treatment, always assimilating the feedback the patient provides.
Take my patient Cori (not her real name). She had been treated by multiple psychotherapists and psychopharmacologists. Cori was bright and empathic, but had a history of failed relationships, depression, and withdrawal when situations soured. Following the loss of a job, Cori was forced to seek support from her aging parents.
All previous attempts at treating Cori had been disappointing. The medications prescribed by Cori’s psychiatrists and psychopharmacologists all created additional problems through their side effects. Psychotherapy was unsatisfactory, too. In part, what caused these failures was the inability of professionals to work closely together. Those who were medically oriented also neglected to take full account of Cori’s feelings of disappointment and helplessness, while they focused on her physiology. Cori fired her last therapist after two years because she had not progressed. That was when Cori first came to me.
Cori’s case was indeed challenging. She needed a full medication review and overhaul, a more functional support system, vocational retraining, and goal-oriented psychotherapy addressing not only her depression, but also practical problems interfering with her daily life. No single issue had overriding priority, and none could be resolved with conventional psychotherapy alone.
What Cori required was a new kind of approach to her treatment, one distinguished by reliable diagnostic assessment, clear-cut goals, monitoring of progress, and above all, coordination between professionals. This is the approach I use when practicing collaborative psychology. As therapist-coordinator of Cori’s case, I orchestrate and monitor the entire operation, collaborating with all the other clinicians and consultants involved, and the key people in her support system. But, this brief description of my experience with Cori doesn’t capture the essence of the treatment. Cori was a complex human being and this new treatment had to be characterized by profound respect for her and her thinking. Cori needed to be a fully collaborating partner in her treatment. A patient, but not just a patient.
In its comprehensiveness and use of psychological assessment, this is a novel approach to psychotherapy. When patients have a combination of symptoms, such as depression, difficulties involving family, children, relationships, or employment, and at times one or more medical conditions, the issues tend to overlap and may be hard to sort out. To find solutions to these complex problems, the therapist must closely collaborate with the patient and all the other professionals involved.