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anonymous wrote:Funny, it’s been about 3 years since the event “ended”, and it’s only now that things are flooding back. I’ve never even really addressed them, and it felt good to get that off my chest – even if it was on an anonymous forum.
I made an appointment with my doctor, I’m going to have him refer me to a psychiatrist. I think a little talk therapy would do me good.
Thanks again.
For psychotherapy, realize that it is very difficult to do psychotherapy if one prescribes medications also. Prescribing medications breaks neutrality in the therapeutic relationship. It is difficult for a therapist to read a person’s unconscious mind if one is blinded by having to think of oneself and protect oneself from malpractice suits all the time – as would have to be done if prescribing at the same time.
Thus, for psychotherapy, I generally would prefer a person go to a clinical psychologist, marriage-family therapist, or licensed clinical social worker. These therapists generally do psychotherapy 100% of the time.
Psychotherapy deals with the software aspects of the mind, not the hardware. If the therapist pays more attention to the medications, then I would not think that therapist can do a good job.
Generally, unless a patient is confused or highly illogical in thought process – where hardware issues of the mind are strongly in play, a good psychotherapist can work entirely independently of the physician. When a person is confused, such a person would generally be referred to physician to be rehabilitated before they can be well enough to benefit from therapy. Then once rehabilitated, the psychotherapist can be once again independent of the physician.
Psychotherapy is a craft. Few people are good at it. Unfortunately, few people realize how valuable a good therapist is. Too much attention is paid to medications.
Many people who practice psychotherapy still have their own issues to work on. These issues blind them when providing therapy. The good therapists have well-balanced personalities and have worked substantially on their own issues to reach balance.
Each psychotherapist has their own point of view and their own level of talent. Each one can take you a certain distance, after which therapy ends. The best ones can take you a very long way. But realize that at some point, therapy ends when the therapist has nothing left to give. That is O.K. If one still has issues to work on and skills to learn, then move on and go to the another therapist. In this way, therapy, like medications, have to be reviewed periodically to see if progress can further be made before switching.
The fit one oneself to the therapist is highly important in order to have a working relationship. Therapy is a working relationship of two people trying to optimize the skills and improve the belief system of one person, the patient.
I would usually recommend getting recommendations for a number of therapists. Then interview each one to see which one fits the best – in point of view, therapeutic technique, personality, comfort, etc.
Do you feel the same way about a physician who isnt prescribing SSRIs or the like. I am seeing a holistic Dr. that has prescribed me Armour and Hydrocortisone. She also does psychotherapy – same issue here?
@DrMariano 57 wrote:
For psychotherapy, realize that it is very difficult to do psychotherapy if one prescribes medications also. Prescribing medications breaks neutrality in the therapeutic relationship. It is difficult for a therapist to read a person’s unconscious mind if one is blinded by having to think of oneself and protect oneself from malpractice suits all the time – as would have to be done if prescribing at the same time.
Thus, for psychotherapy, I generally would prefer a person go to a clinical psychologist, marriage-family therapist, or licensed clinical social worker. These therapists generally do psychotherapy 100% of the time.
Psychotherapy deals with the software aspects of the mind, not the hardware. If the therapist pays more attention to the medications, then I would not think that therapist can do a good job.
Generally, unless a patient is confused or highly illogical in thought process – where hardware issues of the mind are strongly in play, a good psychotherapist can work entirely independently of the physician. When a person is confused, such a person would generally be referred to physician to be rehabilitated before they can be well enough to benefit from therapy. Then once rehabilitated, the psychotherapist can be once again independent of the physician.
Psychotherapy is a craft. Few people are good at it. Unfortunately, few people realize how valuable a good therapist is. Too much attention is paid to medications.
Many people who practice psychotherapy still have their own issues to work on. These issues blind them when providing therapy. The good therapists have well-balanced personalities and have worked substantially on their own issues to reach balance.
Each psychotherapist has their own point of view and their own level of talent. Each one can take you a certain distance, after which therapy ends. The best ones can take you a very long way. But realize that at some point, therapy ends when the therapist has nothing left to give. That is O.K. If one still has issues to work on and skills to learn, then move on and go to the another therapist. In this way, therapy, like medications, have to be reviewed periodically to see if progress can further be made before switching.
The fit one oneself to the therapist is highly important in order to have a working relationship. Therapy is a working relationship of two people trying to optimize the skills and improve the belief system of one person, the patient.
I would usually recommend getting recommendations for a number of therapists. Then interview each one to see which one fits the best – in point of view, therapeutic technique, personality, comfort, etc.
@wondering 388 wrote:
Do you feel the same way about a physician who isnt prescribing SSRIs or the like. I am seeing a holistic Dr. that has prescribed me Armour and Hydrocortisone. She also does psychotherapy – same issue here?
Same issue.
I prefer, if possible, to separate therapy from physical health interventions such as medications, nutrients, herbal treatments, etc. This improves the therapist’s capacity to do therapy. When both are mixed, the psychotherapy is compromised. There is no way around the issue.
Many times, I provide therapy in addition to medication and nutritional treatments to patients. This is because they have no recourse and cannot do psychotherapy with another health care provider. But I realize that the therapy I do cannot be better than if it is done by a separate practitioner, even with the experience I have in doing therapy. Giving something like a medication to a patient simply blinds the therapist from seeing certain issues or reading what the patient may be thinking about unconsciously. It often reduces therapy to giving advice.
The form of therapy which may work in combined mode is therapy which does not deal with unconscious issues or deep psychological issues. This is pure cognitive-behavior therapy. This form of therapy treats a person like a black box and only external behavior or conscious thoughts matter. It stays only in the here-and-now or present.
@DrMariano 431 wrote:
Same issue.
I prefer, if possible, to separate therapy from physical health interventions such as medications, nutrients, herbal treatments, etc. This improves the therapist’s capacity to do therapy. When both are mixed, the psychotherapy is compromised. There is no way around the issue.
Many times, I provide therapy in addition to medication and nutritional treatments to patients. This is because they have no recourse and cannot do psychotherapy with another health care provider. But I realize that the therapy I do cannot be better than if it is done by a separate practitioner, even with the experience I have in doing therapy. Giving something like a medication to a patient simply blinds the therapist from seeing certain issues or reading what the patient may be thinking about unconsciously. It often reduces therapy to giving advice.
The form of therapy which may work in combined mode is therapy which does not deal with unconscious issues or deep psychological issues. This is pure cognitive-behavior therapy. This form of therapy treats a person like a black box and only external behavior or conscious thoughts matter. It stays only in the here-and-now or present.
I am just curious in the amount of training that MD’s get in SSRI and related drugs who are not specialists The reason being that so many GP are handing out SSRI’s and other related drugs like it was candy with what I see as no specialize training. One time I asked a my GP about and SSRI and its interaction with brain chemistry. He had to go look it up in the medical book to its function. When I saw this it kind of made me lose respect for a Dr that should have known about it off the top of his head.
there are some psychologists who are getting trained to prescribe psychotropics. Generally speaking, there will do one modality (psychotherapy or medicine) or the other, but not both. A local psychiatrist decided to open part of his practice to doing therapy again. After several months, he changed his mind and referred out his therapy patients and kept them on for the medicine. On the other hand, there are psychiatrist who are excellant therapists. I have benefited from hours of training by a few.
@hardasnails1973 442 wrote:
I am just curious in the amount of training that MD’s get in SSRI and related drugs who are not specialists The reason being that so many GP are handing out SSRI’s and other related drugs like it was candy with what I see as no specialize training. One time I asked a my GP about and SSRI and its interaction with brain chemistry. He had to go look it up in the medical book to its function. When I saw this it kind of made me lose respect for a Dr that should have known about it off the top of his head.
Medical school training in pharmacology is at the level of a Ph.D pharmacologist. It is that good. No lower level medical professional receives this level of training.
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A physician is a person who has learned to teach him or herself. Almost all of a physician’s knowledge is self-taught.
The pre-medical education, medical school and residency education provides a unique knowledge framework, medical method of thinking, and initial modeling and experience that a physician will use as a foundation to build his or her knowledge-base with their post-graduate continuing education and work experience.
A key concept is that medical education is a continuous lifetime experience. It never stops.
Medicine is a craft. A physician is a craftsman, who continuously hones his or her skills.
What makes a medical doctor different and empowered is the foundation that their education provided. It is a perspective that is different from other fields.
Today, the difference in extent of my knowledge-base between now and medical school is like the difference between psychiatry residency and the 6th grade. It is amazing how simple medical school is in comparison to what I am doing today. Of course, medical school, to me was a ton of fun. So it was very much like elementary school as an environment.
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One of the biggest problems in medicine is that physicians (such as family physicians and general practitioners) are given very little time to provide care for their patients.
For example, the average family physician I know, has only about 6 minutes to give to a patient before having to move on to the next patient. This is largely an outcome of managed care. A family physician has to do this in order to break even and not go out of business.
This time-limited model for medical care has warped the field of medicine in that physicians have developed cookbook style assessments and treatments to allow a quick diagnosis and treatment of a patient.
As a result of managed care, cookbook style thinking, unfortunately, has become, endemic in the field of medicine. Since it works “O.K.”, allows them to make a living, and poses relatively little risk, physicians have gravitated to this practice. It certainly allows one to have personal time and a lifestyle outside of medicine.
Cook-book style thinking also has allowed lesser-trained medical providers to provide medical care. Nurse practitioners and physicians assistants rely on cook-book thinking to practice. From my point of view, it is a huge drop in the quality of care, but there are so many patients, someone has to do it. There simply are not enough physicians.
Unfortunately, cook-book style thinking also dumbs-down the craft of medicine. It lulls physicians to stop developing their craft.
These days, physicians often engage in category thinking. They give category medications for category diagnoses. This is classic cookbook thinking. They often don’t think below the surface – to actually ask what is causing the patient’s illness. They stopped asking why or how a patient came to be ill. Just give the category medicine for the category diagnosis then shoo the patient out of the room in order to bring the next one in.
Unfortunately, medical illnesses often are highly complex entities. For example, diabetes and heart disease are complex entities. To get a person “well”, it takes much more work than to simply given them a category medicine.
The watchword is “wellness”. This is an ideal which is not being achieved. Instead, more people are becoming sick.
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To repeat: Medical school training in pharmacology by the 3nd year of medical school is at the level of a Ph.D pharmacologist. It is that good. No lower level medical professional receives this level of training.
With the dumbing down of physician skills from cookbook thinking, however, physicians often forget their pharmacological training. They forget how they got pimped about how Propranolol works. Rather, too easily, they give a category medicine for a category diagnosis.
For example, if a person is depressed, give a depression medicine. Thus, you have the GP handing out an SSRI without thinking about what it actually does. Since SSRIs are “relatively safe”, this is possible, though often not effective. But then, if the patient believes it will work, the placebo effect reigns supreme. The powerful effect of a father-figure physician given a medication also enhances the placebo effect of the medication.
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To ask the question of how an SSRI interacts with brain chemistry is actually not a fair question to ask of a GP. I would not think less of him or her if he did not know.
I certainly would not expect a GP to answer that question. A GP has breadth but not depth of knowledge. Using chess as an analogy, they can think only one or two moves ahead. Cookbook thinking predominates. After all, they only have 6 minutes to see a patient. What can one expect in 6 minutes?
Even a well-trained psychiatrist would have difficulty answering that question. I know. I ask.
The reason I say this is that very few people actually have more than a rudimentary understanding of brain circuitry – psychiatrists included.
Fewer still have an understanding of how the signaling systems interact.
Even fewer people have an understanding of how the nervous system interacts with the endocrine and immune system.
Brain circuit interaction is actually not taught well in psychiatry in more than a rudimentary way. (wow!). The teaching in other fields is even worse.
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Why? How did this happen?
A contributing factor to this problem is what I call the problem of Occam’s Razor.
Scientific thought in medicine has always followed the idea that one should search for the simplest solution to a problem. The simplest solutions is thought to be the correct or right solution.
Thus, mental illness has been dominated by attempts to find the single explanation, the single cause of mental illness.
This has lead to gross oversimplifications – such as mental illness is a “chemical imbalance”, or that depression is a serotonin deficiency, that schizophrenia is a dopamine-excess problem, etc.
The idea that multiple systems interact to cause an illness is not in the forefront of medical thinking – outside of some alternative forms of medicine. Medical scientists forever look for the panacea for an illness. Unfortunately, a single intervention cannot usually cover all of the pathology that contributes to the development of a complex illness.
When I read about the pathophysiology of a mental illness, such as Bipolar Disorder, many of the causes are listed. But the treatments discussed seem to forget about the pathophysiology. Few people, it seems, can put it all together, even when the information is right in front of them.
The tenet of Occam’s Razor blinds medical thinking.
A mental illness is a highly complex illness – physically. Unless it is approached that way, we only have partial treatments that work at best little more than placebos.
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Some closing thoughts:
Primary care physicians and their extenders (Nurse practitioners and Physician Assistants) provide more than 75% of all mental health care. Nurse practitioners and Physician Assistants have nearly zero mental health training. This includes a large amount of often inappropriately prescribed medications.
About half of the visits to a primary care physician involve mental health issues.
A good rule of thumb is that a person whose medical chart is thicker than 1-inch has a diagnosable major mental illness. Period.
Combine all of the psychiatrists, psychologists, licensed clinical social workers and marriage-family-therapists together and you find they provide only 25% of mental health care.
It is important to provide primary care physicians with better mental health training so that they can provide better care for patients. since there are not enough allied mental health specialists to provide care.
Ideally, family practice residents and other GPs should do rotations in the psychiatry department just as psychiatry residents do rotations in internal medicine and neurology. Unfortunately, I did not see the family practitioners do this in my program.
Ideally, family nurse practitioners and physician assistants should have a psychiatry rotation as part of their training.
Family practice residency should do a year rotation in psychiatry – and thus should be a four year residency rather than a three year residency as it is today.
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@DrMariano 1287 wrote:
Medicine is a craft. A physician is a craftsman, who continuously hones his or her skills.
—I grew up in a family with a couple of doctors, one being my father, who was a pathologist, the Chief of Staff and
head of his own lab, so he considered himself the doctor’s doctor, as they all came to him for the lab results. He
had VERY strong opinions about other doctors, and surprisingly not usually real favorable ones. If I remember
correctly, his assessment after 50 years in his field was that: 80% of doctors were so/so, and half of these were
in it for the power and the money; of the other 20% that were pretty good, he said only 5% were excellent and
that those were the ones you could likely trust not to kill you. My father, of course, put himself in the excellent
category, and wore a button that said THE BEST as proof… 😉 which is probably fair, as he was deeply devoted
to doing an excellent job. Though it should also be mentioned that many of his “patients” were already dead, so
he didn’t have to worry about killing them.I think that my father, being an old time doctor in his thinking, did see medicine as a craft, and struggled with
those who didn’t learn anything beyond their medical school days. This is a common problem I’ve had too, as a
patient (and I know I’m not the only one), with doctors I’ve paid to see, who could not give me help I needed,
and sometimes resented me asking too many questions that made them uncomfortable with what they did not
yet know. As I have read, MOST doctors do not in fact go beyond their medical school learning in terms of new
research and do NOT read research papers. Kent Holtorf wrote a paper Why Doesn’t My Doctor Know This, that
addresses this issue. It really is a HUGE problem.
Nice article sharing..First meditative state I knew was 12 years in office as a psychotherapist. Nice music, with an ocean sound … calm voice telling me to relax … Appeal to feel my hands warm … relax the muscles of my face … think I am safe in the world …Psychotherapy consists of two (or more) people who are sitting in a room talking. At least one of these people are trained to help people change. At least we have something of their lives, they want change.
Its really very nice information.Psychotherapy is a treatment for psychological help, the problems of emotional nature, where a trained person deliberately establishes a professional relationship with the patient to (a) remove, alter or delay existing symptoms, (b) mediation disrupted modes of behavior, and (c) promote growth and development of positive personality.
я фигею. такое видео где снимали интересно? а? русский инцест а
сын пердолит пьяную мать до потери пульса. блин
жестко. вот ссылка
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