Posted by SLS on November 21, 2009, at 23:23:24
In reply to Re: No benefit to adding psychotherapy to medicati » SLS, posted by floatingbridge on November 21, 2009, at 21:16:31
Hi FB.
> > One thing I don't like seeing is a psychotherapist disregarding the biological nature of affective disorders and place the responsibility of mental health on the psyche of the patient. This is a cruel sort of sabotage.
> Yes, I absolutely agree with you. And here in the sunny west, that attitude has trickled down to the general population of pop-psychology readers. The same attitude that blames a Parkinson's patient for precipitating illness by too much negative thinking, or even, karma!
>
> Yesterday, my pdoc showed me the latest publication on managing major depression (a slim book by some neuroscience organization). Interpersonal therapy--or any therapy--was suggested as an adjunct in the 4th (or last) step in dealing with major depression. Therapy was placed in the same tier as ECT, VNS, and rTMS. I was shocked. I mean, therapy does not help some people, for many reasons--that I understand. To wait to try it until one presents as ready for last and most invasive measures does not seem wise. What a disconnect, imho.Gosh.
What comes with the next tier - positive affirmations and psychosurgery?
You know, it would make a hell of a discussion to consider whether or not psychotherapies should be included in a treatment algorithm for depression, and if so, where they should be positioned.
I favor the use of a psychological evaluation at some point, perhaps as part of an intake process, rather than a rigid placement of psychotherapy in a treatment algorithm. For MDD and BD, I'm not sure there is enough scientific evidence that psychotherapy is effective such that it should deserve a prominent role in treatment. I would prefer to establish an indication for psychotherapy first through psychometric testing or some other form of psychological evaluation. This could help set up a treatment protocol that includes both somatic and psychological therapies.
- Scott
poster:SLS
thread:926342
URL: http://www.dr-bob.org/babble/20091117/msgs/926498.html