Doctors, Psychiatrists and Psychotherapy
When I tell people to see a mental health professional, I recommend they get someone who specializes in whatever mental illness the person has. This is just common sense. You don’t go to a neurologist when your foot hurts.
I also tell people to get a therapist who specializes in their disorder. Again, this makes sense. Honestly, if your therapist is used to hearing the woes of the Real Housewives of Some Rich Place then they may not be the best choice for a person with major depressive disorder.
I tell people to get a therapist for their mental illness because psychiatrists don’t do psychotherapy.
Doctors Don’t Do Psychotherapy
I almost never think or talk about psychiatrists doing psychotherapy. This is because most of them just don’t do it. Psychiatrists are trained in psychotherapy, theoretically, but for a long time now, they have just been doctor with prescription pads and specialized knowledge of psychotropic medication.[push]Psychiatrists doing therapy started to become rare years ago because generalized “talk therapy” fell out of favor and there just weren’t enough doctors for all the mentally ill.[/push]
If you’re seeing a therapist who you really should be seeing is a licensed psychotherapist. These people have a masters or doctorate in their chosen mental health field, a clinical supervised residency and then are licensed by a governmental organization. These people are not touchy-feely-feel-good-hold-hands-sign-kumbaya kind of people. These are highly educated people who know what they are talking about. They are not, however, MDs and cannot prescribe meds.
And theoretically, they could also be a psychiatrist.
Why Psychiatrists Don’t Do Psychotherapy
But the thing is, psychiatrists make a lot more money prescribing drugs in ten minutes than they do talking to someone for an hour. They just do.
And moreover, in many places there just aren’t enough quality psychiatrists to go around so they don’t have time to sit and talk to you even if they wanted to.
And while I do think the health care system would work much better if doctors actually took time to talk to their patients and practice psychotherapy that’s just not how things are done. And, in the defense of all involved, it is much more difficult to be exceptional and current in both disciplines rather than just one.
And the thing about therapy is that I think you have to become more invested in your patient’s well-being. When you talk to someone frequently, for an hour each time, you get to know them and you may even start to care about them. Doctors really don’t have to make such investment.
But I Found A Doctor That Does Both
Not surprisingly, she is a resident. She’s young and energetic and fresh and still has that new-doctor smell. She still thinks she can change the world. It’s adorable, really. She seems to actually want to help.
And yes, prescribing doctors might want to help too, but it’s impossible to tell what with their granite demeanor and lack of facial expression.
So I’m Back in Therapy
So I find myself in therapy, again. She wanted to help so I’m letting her have a go at it. I think the result will be exactly nothing, but so be it. If I never change anything then nothing will ever change and I doubt it’ll get any worse.
(Although even that is generous. I find therapy can actually make disorders worse, particularly for high-functioning people. I suspect it’s because people such as myself have built up extraordinary strong-holds against the disease trying to kill us and by dredging it up and talking about it the stronghold gets weaker.)
She didn’t ask me what I wanted to get out of therapy, which they always seem to ask, and it’s a good thing because really, I don’t expect to get anything from it. The only benefit I see is having a person I can be honest with for an hour. Which in and of itself is beneficial. But actual therapy goals? None really.
Therapy Is Good
I’m not suggesting that people don’t get therapy. Just the opposite, actually, I recommend everyone try therapy. Statistically you are more likely to get better with a combination of therapy and medication than you are by either alone. So yes, you should get therapy.
But I’ve had therapy. I’ve had so much therapy I should get to have my own license. I just can’t think of a single thing that a therapist could tell me that would help me. I’ve heard it all. I’ve done it all. It’s nothing personal it’s just that after years of the stuff it’s all pretty routine.
Nevertheless, I’m giving it a shot. Why not? I’ve tried the same drug oodles of time in different cocktails, why not try oodles of therapy? If nothing else it’ll give me a chance to get inside this young doctor’s brain for a while. And that itself is also rather interesting.