Patients with mood, anxiety and other psychiatric disorders often benefit from treatment that includes the use of psychiatric medications. Before embarking on such treatment, careful assessment involves a review of all symptoms, past and current, past experiences with psychiatric medications, and a discussion about the patient’s feelings and beliefs regarding the use of psychiatric medication. Often, other care-givers (e.g., primary care physician, obstetrician-gynecologist, endocrinologist, and other medical specialists) are consulted, with the patient’s permission, in order to incorporate all factors that may have a bearing on the likely effectiveness and safety of a proposed medication regimen. When psychiatric medications are prescribed, care is taken to be available to address any possible concerns regarding side effects. Recognizing that for some patients, using psychiatric medications can be somewhat unsettling in the beginning, ongoing accessibility and attention is provided in a calm and open setting.
Whether patients are treated with psychiatric medications or not, the best psychiatric treatment involves the establishment of a therapeutic alliance, comprising trust, openness, and availability. In some cases, patients receiving psychiatric medications are seen separately by a psychotherapist other than the treating psychiatrist. Although careful attention is made to safeguard the psychotherapy under the treating therapist, administering psychiatric medication is a process that continues to incorporate understanding, support, and a therapeutic alliance that welcomes questions and concerns and allows for ongoing discussion with the treating therapist.
Psychotherapy is sometimes used as the only treatment, without the use of psychiatric medications. In other cases, psychiatric medications are effective both to effectively treat the primary psychiatric conditions and also to enhance responsiveness to psychotherapy.
Psychotherapies that are offered include:
Cognitive Behavioral Therapy (CBT)
Cognitive behavioral therapy is based on the idea that thoughts cause feelings and behaviors. The therapy emphasizes the identification of these thoughts, and how these thoughts may be distorted. The therapy helps patients become aware of inaccurate or negative thinking, and as a result, over time, patients learn to view stressful situations more clearly and accurately, and respond to them more effectively, and without automatic negative feelings that result in depression, anxiety, or irritability. CBT is generally focused on specific problems, is goal-oriented, and involves “homework” in which one learns skills that can be applied to daily challenges so that they no longer precipitate negative feelings and unproductive or maladaptive responses. Although CBT may not cure a condition or make an unpleasant situation go away, over time, skills are learned that enable one to cope with situations in a healthy way and to feel better about oneself.
Existential psychotherapy is a type of talk therapy that concentrates on each person’s freedom and responsibility. The emphasis is on identifying the role of responsibility in one’s life, and the ways in which free choice can direct the course of one’s life. The therapy facilitates the process by which one can find meaning in life, not by depending on others for validation, but rather by understanding that validation comes from within rather than from others. Although at times, the therapist and the patient reflect on the past, the emphasis in existential therapy is to searching for awareness of the challenges of the present and the available options available that make decisions that will affect the present and the future.
Interpersonal Psychotherapy (IPT)
Although depression may not be directly caused by interpersonal events, it usually affects relationships and roles in relationships. Using a directed and focused approach, IPT focuses on issues which generally fall into one of four basic problem areas which often contribute to depression: unresolved grief, role disputes or conflicts e.g., when the patient and others have different expectations about their relationship, role transitions (e.g., when role changes cause difficulties in feelings and behavior), and interpersonal deficits (e.g., problems with forming and maintaining good relationships).
Supportive psychotherapy integrates dynamic, cognitive-behavioral, and interpersonal therapies, with the aim of reinforcing healthy and adaptive patterns of thoughts and behaviors. Rather than emphasizing subconscious motives the emphasis is on the provision of support and encouragement in order to facilitate healthy defenses mechanisms, especially as these bring about healthy interpersonal relationships.
Couples therapy is therapy between partners and emphasizes recognition of conflicts and improving relationships. Couples therapy generally brings couples or partners together for joint therapy sessions. Working with the therapist, strengths and weaknesses in the relationship are identified in an effort to understand the sources of conflicts. Skills (e.g., communicating openly, problem solving together, discussing differences rationally, etc.) are learned with the goal of solidifying relationships. Couples learn to make thoughtful decisions about how to rebuild their relationship in a positive way that enables both members of the couple to attain gratification and fulfillment individually and as a couple. Although the focus is on repairing and rebuilding relationships, in some cases, despite all attempts, the therapy may focus on helping the members of the couple go their separate ways.