Have Psychiatrists Forgotten About Psychotherapy as an Effective Treatment?

I have had contact in the past several years with anxious, depressed, traumatized  people who, despite not getting any help from the drugs they were prescribed by their family physicians and psychiatrists, were not told that they might get help from a psychotherapist.  This, to me, with respect to non-psychiatrist physicians is understandable, albeit sad; with respect to many psychiatrists, is inexcusable,    

Psychotherapy has been in existence for over 100 years now.  Granted, the orthodox Freudian analytic method has proven to be not very effective for most patients, but we know a lot more now about methods that are effective.  And we also know that a person’s upbringing and attachment history has much to do with the lives they lead as adults. This information is known, I think, by many in the general population. But many psychiatrists don’t seem to know that. Or at least not believing it.

Most psychiatrists used to practice psychotherapy, but  for a variety of reasons, stopped even getting that training for it  One reason was because psychologists and masters level practitioners began to do psychotherapy and charged a lot less than psychiatrists,. Therefore the latter did not have a financial incentive to continue to practice psychotherapy.    Secondly, the inefficiency of Freudian analysis as a treatment for most people and lacks as a personality theory, turned many of them off of psychotherapy.   The result is many of them today just prescribe meds and do med management.   If specific meds are not working, the remedy is trying different ones.  Many times four at a time.

A few years ago I read an article in the New York Times by a psychiatrist who regretted no long practicing psychotherapy because his wealthy lifestyle depended on his seeing patients for 15 minutes at a time,. This was just to check on how they were faring on their meds.  And if a patient needed to talk to him for longer than 15 minutes, it played havoc with his schedule. I thought that he might have better started practicing psychotherapy again with more professional satisfaction, if being somewhat less wealthy.

Here are two examples from my practice of this troubling issue.  

A man has a daughter who was in one of the twin towers during the 9/11 attack and who barely escaped with her life. They are very close and he heard in great detail from her abut what she went through. The result was that he was traumatized himself and the PTSD symptoms lasted for years. He tried to get help from a variety of physicians , but all they did was prescribe a variety of psychotropic med. They didn’t help and he was still very anxious.  When he went back to New York, which he had to do on occasion for business, he felt frightened and anxious, had trouble sleeping and could hardly wait to come back home.  He was referred to me by a friend and I did two sessions of EMDR treatment. He accessed his intense fear, we did the EMDR processing and he was cured of his PTSD.   He was soon after able to go back to New York City, actually had an enjoyable time there, and was able to go to Ground Zero with little anxiety. He later o talked with his daughter. She had tended to avoid him because of his obsession with 9/11. But she was now able to share with him her leftover trauma from her ordeal, probably because he was now calm enough to listen to her. She began to realize, from his telling, that she probably still had anxiety about her ordeal and considered getting some treatment on her own.  

(Note that I am not writing about this as an endorsement of EMDR as a panacea for PTSD. Many people with more complicated attachment histories would take much longer for relief and probably would need f other types of therapy, perhaps with EMDR as an adjunct, to become free of their PTSD.)

Another example.

Years ago, while still practicing in LA, I was referred a young man for mandatory treatment by the courts because of a history of violent behavior. Even though only in his early 20;’s, he had been in jail a number of times. He was also seeing a psychiatrist, who had prescribed a variety of drugs which were unhelpful. I called the psychiatrist to find out what he knew of his history, which included having been raised by a violently abusive father in an area that was controlled by gangs. He also had been bullied by gang members as a child, probably because he was somewhat better off financially than them, was obviously intelligent and very handsome. The older members of another gang kind of adopted him and protected him from the bullying of the rival gang. He became a member of this gang as a teenager and was involved in a number of violent illegal activities through the years. But having some acting ability and wanting a better life style, he had gone to an acting school. He was doing well there until he punched a girl in the face, breaking her jaw, after she had contemptuously blew cigarette smoke in his face when he had approached her during a break in the class. It was clear to me that her treatment of him had resulted in his feeling humiliated and enraged at her. When I talked to the psychiatrist, he knew nothing of his history except that he had been knocked unconscious once in a gang fight. He thought his violent behavior was solely due to that injury!

I have seen other people in psychotherapy with similar stories of not getting help from drugs prescribed them by psychiatrists and other health care professionals.  And these professionals had not even questioned them about their childhoods and other important life events. 

I am not saying that drugs are not helpful for some people.  The science behind them has been shown to be faulty and the placebo effect can account for some of the benefit people get  But I have had numerous clients through the years swear by them.  And psychotherapy doesn’t work for everyone.  Also, no therapist is effective with every patient.  But when drugs don’t seem to be working, it behooves these medical people to refer their patients to someone who can potentially help them, and that is a well-trained psychotherapist.    When a new clientt of mine is getting medication from an internist or other physician and I get a release of information from them, I always contact them to talk about the client. In this way we can collaborate in the client’s treatment and, of equal importance, I can help to inform the physician about the benefits of effective psychotherapy.