Random, Random 2.0

[ponchi101]

I am talking about psychotherapy that only involves, for lack of a better description, talking to a therapist, with the possibility that if such a therapist is a licensed MD, you can receive medication. In several cases, as for example, my brother in law, who is a licensed psychologist, he can't medicate and his method is simply conversational (which the therapy that I have doubts with).
The DSM is indeed one of the reasons I do not trust the craft. Symptoms are, on many diagnoses, multifaceted. It can be that you suffer from insomnia, or you sleep too much. You lose your appetite, or you indulge in binging. You never call a parent, or you can't make the slightest decision without consulting them. I always say: so, which is it?
Can of worms freshly opened, sir

[dmforever]

I am talking about psychotherapy that only involves, for lack of a better description, talking to a therapist, with the possibility that if such a therapist is a licensed MD, you can receive medication. In several cases, as for example, my brother in law, who is a licensed psychologist, he can't medicate and his method is simply conversational (which the therapy that I have doubts with).
The DSM is indeed one of the reasons I do not trust the craft. Symptoms are, on many diagnoses, multifaceted. It can be that you suffer from insomnia, or you sleep too much. You lose your appetite, or you indulge in binging. You never call a parent, or you can't make the slightest decision without consulting them. I always say: so, which is it?
Can of worms freshly opened, sir

I will only say that my experience with psychotherapy is vastly different from what you described. So maybe a lot depends on the individual client, therapist, and how they work together. If all I knew of psychotherapy were what you described, I would have exactly the same opinion that you do.

Kevin

[JazzNU]

Huh. That was not the answer I was expecting and not how I was interpreting the arguments being made. Good question @dry.

[ponchi101]

Are we talking about two different things? If maybe this makes it a bit clearer: I am talking about psychoanalysis that can be held via SKYPE, and which I see more and more being used.
Psycho-facetime, if I may.

[dmforever]

Are we talking about two different things? If maybe this makes it a bit clearer: I am talking about psychoanalysis that can be held via SKYPE, and which I see more and more being used.
Psycho-facetime, if I may.

I"m sure there are people here who know much more about this than I do, so please correct me if I'm wrong, but as far as I know, the method of how a client interacts with a therapist/psychologist/psychoanalyst doesn't differentiate it or define it. Psychoanalysis could be done in person or via Zoom/Skype or on the phone. From my limited understanding, the framework from which the doctor works and the types of focuses (I just can't use the word foci, sorry) that the discussions have make something psychotherapy, which is very different from other forms of therapy.

Kevin

[dryrunguy]

Okay. I am not sure where to start.

I will say this. I benefited greatly from seeing a therapist in my mid-twenties. That was when my therapist helped me develop what she called a "toolbox" for dealing with the struggles I was experiencing at the time. That "toolbox" is something I still use to this day.

In the mental health arena, "psychoanalysis", which is a term I haven't heard in ages upon ages, can take many forms. There's therapy (or psychotherapy), talk therapy, peer-to-peer support, etc. I supposed AA and NA fall into this category as well, though who leads the group, and their qualifications to lead such a group, can vary.

There's also a big difference between the "worried well" (people are really doing fine for the most part but don't have a specific diagnosis--they just want someone to talk to because they have no one in their personal lives where they feel comfortable talking about what they are feeling) and people who are seeking treatment for a specific diagnosis where evidence suggests therapy, talk therapy, etc., have evidence-based medical efficacy for some folks (but not everyone).

Then you have those dealing with addiction (whether alcohol, drugs, or whatever). Many of these folks will start their treatment journey with a primary care professional who uses SBIRT (Screening, Brief Intervention, and Referral to Treatment) techniques, which includes Motivational Interviewing techniques, to assess a person's readiness to enact behavior change and seek treatment from a behavioral health professional upon referral, which can include talk therapy, etc. For severe addictions such as opioids, this can involve medication assisted treatment (MAT).

Then there's the difference between seeing a psychologist (who typically engage in therapy, talk therapy, etc.) and a psychiatrist (an MD who can prescribe medication if DSM-V diagnostic criteria are met [sorry to mention DSM-V again]). For the record, the vast majority of psychiatrists I have encountered in my professional life, with the notable exception of the psychiatrist I wrote speeches for and coordinated media interviews for when I worked for the federal Center for Mental Health Services [Bernard Arons, MD], have been frightening people.

Then you have the people living with serious and persistent mental illness, who are typically treated with a combination of therapy, talk therapy, etc., and medication. Some of these folks can live independently in the community with sufficient supports. Others cannot. Some require institutional settings.

So, again, when I read the term "psychoanalysis", which again is a term I have not seen used in a very long time, and see it lumped within a singular category in terms of medical efficacy and evidence, that's a little worrisome.

That said, I will agree there are A LOT of bad therapists out there who are more concerned with stringing clients along for as long as possible without trying to reach a real, achievable, and client-focused treatment objective.

And then there are people like my brother, a therapist, who are perfectly comfortable and empowered to say to a client, "I'm not the right person to help you" or "You may not believe it at this moment, but you really don't need me anymore."

[Deuce]

I am fascinated by psychology... but I have little faith in most psychoanalyses.
The reason for this is because I find that the psychological professions (psychiatry, psychology, psychoanalysis, etc.) try to mimic their physical counterparts. By this, I mean that they try to make it into an exact science.
While my broken arm will heal pretty much the same way as your broken arm, the same is not true of psychological wounds or problems. This is because, with respect to obvious differences owing to gender, we are all extremely similar in our physical construction - but we are very different in our psychological make-up. Part of the differences are genetic - but most, I believe, are owing to our different experiences in life. These experiences go a long way to forming our identity, or ‘personality’, or ‘character’. And I feel that the psychological professions treat psychological issues as if there is a blueprint which applies to everyone; as if there are universal solutions to given problems, and if the ‘patient’ doesn’t respond positively to the ‘remedy’, the patient is blamed for not making the proper effort.
In short, physical medicine is an exact science - because our physical wounds heal the same way. But psychology is not an exact science - not even close... but it is treated as if it is.

I believe that the psychology based professions can be quite dangerous, and so possess the potential to do great harm - in that there is obviously a significant hierarchy involved. The relationship between ‘doctor’ and ‘patient’ is not an equal one: the latter goes to the former for answers and solutions, and so will take whatever the doctor says as gospel. The doctor delves into his DSM book - regarded as the blueprint of psychological problems - and comes up with what can only be described as a universal solution. But there are no universal solutions in psychology - because we are all so very different, and our life experiences - which mold us - are so very different!
The doctor and patient are almost always complete strangers to each other - and so what qualifies the doctor to help a complete stranger with their psychological issues? I maintain that to provide such help, one needs to know and understand the other person intimately - which I do not believe can be accomplished within the very restrictive ‘relationship’ of doctor - patient, in which there are persistent time limitations, as well as a significant financial reward for one party given by the other party. This is the definition of an unequal and unbalanced relationship. Because the patient is almost always desperate for answers and solutions, and the doctor passes him/her self off as an ‘expert’ in matters of the workings of the mind, the patient is likely to follow any advice the doctor gives, no matter how absurd or damaging it may be. Blind trust is a dangerous thing. But the reality is that these therapists are not perfect people. They possess flaws, as well - sometimes very significant ones which influence their perceptions and judgments. And so to blindly trust a therapist simply because he/she claims to be an ‘expert’ is a very dangerous path upon which to embark.

In the past 25 years or so, there has been a massive increase in ‘diagnoses’ of children by the psychiatric profession. It began with what they called ‘learning disabilities’. Then came things like Attention Deficit Disorder, and ADHD... And, of course, the drugging of children naturally followed.
For several years, I worked with children who were so diagnosed, and I found it disgusting. It is a profession which adores labels. Labels can be damaging - especially to children. Imagine what it does to a child to be labelled to have a mental ‘disorder’ or ‘disability’ or ‘disease’. The kids were mere guinea pigs...

There was one 6 year old girl I was brought in to work with because she was ‘disturbing her grade 1 class’. On my first day with her, I was given a colouring book, crayons, and scissors and sent to a separate room, where it would be only the child and I. I was told by the teacher “Be careful with the scissors - she likes to stab people with them.” I simply smiled and said “That won’t be a problem.” And it never was in the 2 years I worked with her. I never had any problems with her. She was a wonderful child - but if you listened to the teachers and psychologists, etc., you’d think she was the devil incarnate. She had psychologists, psychiatrist, neurologists, ‘behaviour modification therapists’ (a horrible title), guidance counsellors, and teachers all trying to ‘fix’ her, with those who could prescribe pills doing so every 2 weeks, in an effort to find the ‘right’ pill that would make her fit into the box that they desperately wanted her to fit in. I told them all “STOP! Stop trying to fix her - she’s not broken! She is a wonderful and beautiful child who only acts out because you’re all pawing at her and trying to get her to be what you want her to be. I never have any problems with her - because I treat her with respect, and I enjoy who she is, without trying to change her. It’s up to YOU to adapt to her, not the other way around!”
Some people believe that many of the so-called ‘learning disabilities’ that children are ‘diagnosed’ with are in fact teaching disabilities... and that, when a subject which interests the child is presented in a compelling manner, the ‘learning disabilities’ and ‘attention deficits’ suddenly vanish. Count me as one of the believers in this theory. I’ve seen it played out.

Obviously, I’m only scratching the surface of the subject here - a proper discussion would take weeks, at least.
For anyone interested in psychology, I suggest the following books: ‘Toxic Psychiatry’ by Peter Breggin... ‘The Myth of Mental Illness’ - or any other book by American psychiatrist and psychoanalyst Thomas Szasz... ‘Against Therapy’ and ‘Final Analysis: The Making and Unmaking of a Psychoanalyst’ by Jeffrey Moussaieff Masson (former director of the Freud Archives).

[dryrunguy]

Sorry, one other thing about technology assisted care, which includes the delivery of behavioral health services via technology, what other choice have people had during the age of COVID? Technology assisted care has been a mainstay in delivering behavioral health services for people in remote, rural areas for a long time. Many people and many communities do not have a local behavioral health provider. Technology assisted care is the only option available.

COVID exacerbated that reality.

I would stop short of saying technology assisted care in the behavioral health arena cannot be effective. But it is definitely limited. E.g., there's a big difference between being able to talk to a person face-to-face, only face-to-face, and not seeing that person's whole body, e.g., legs crossed, arms crossed, etc.) So while technology assisted care may be imperfect, for some populations, that's all they have at their disposal because of logistical, pandemic-specific, or broader health care access issues.

In case it's useful, there's a network, Project ECHO, that for years has been dedicated to telemedicine delivery in hardly reached communities, including behavioral health: https://hsc.unm.edu/echo/embedded-conte ... ns-us.html. The company I work for has been a partner of Project ECHO for about 5 years or so.

[JazzNU]

I agree with @dry where I haven't heard the word psychoanalysis in a long while. Therapy, whether conducted by a therapist, psychologist, or a psychiatrist, isn't necessarily psychoanalysis and the differences in the degrees each person holds with their title doesn't necessarily change their therapy approach. Every level of study uses the DSM V (I always want to say DSM IV).

Unless the terminology has changed in more recent years, entirely possible since again, haven't heard it in a while, here psychoanalysis is a more intensive therapy that deals with Freud's teachings to work toward correcting more abnormal behavior. So a lot of focus on getting in touch with the unconscious - repressed memories and the like, delving into childhood many times. Freud type things.

Now I believe the word can be and has been used more generally in the last couple of decades and what the person is trying to convey by using that term is that they are in intensive therapy occurring several times a week vs the more common once a week therapy appointment.

Also, just an FYI, I'm sure it differs from country to country, but standard practice in the US is that if you undergo therapy and are being treated by a therapist or a psychologist, you are supposed to have a psychiatric consult early on in that process where the MD evaluates you and determines if you are in need of medication as part of your treatment. This is definitely not always followed even in the US, I would guess this is especially the case with independent psychologists, but if you're part of a hospital network for instance, it's the standard practice that is followed while getting treatment.

[dryrunguy]

After thinking about it more, I probably approached this discussion incorrectly. So I'll shift gears.

Ponchi, if you have a friend or family member who says, "I'm thinking about taking my own life," or "I'm thinking about blowing up a government building," or "I'm thinking about killing my ex," and if you don't subscribe to the DSM-V or anything that falls within the category of what you would call "psychoanalytics"....

What would you suggest your friend or family member do as a prevention/mitigation/intervention strategy?

[Deuce]

There is no general or universal answer/solution... It is entirely dependent upon the make-up/history of the person making the threat, the make-up/history of the person intervening, and the nature and depth and history of the relationship between the two parties.

[JazzNU]

After thinking about it more, I probably approached this discussion incorrectly. So I'll shift gears.

Ponchi, if you have a friend or family member who says, "I'm thinking about taking my own life," or "I'm thinking about blowing up a government building," or "I'm thinking about killing my ex," and if you don't subscribe to the DSM-V or anything that falls within the category of what you would call "psychoanalytics"....

What would you suggest your friend or family member do as a prevention/mitigation/intervention strategy?

On the last two, is alerting the authorities an option?


Maybe a few less charged examples for @ponchi to consider unless he prefers those (cause that's a lot to take on) -

You have a very active friend that is always doing something, always social. Let's say one of your tennis buddies, who hasn't shown up to play in months and who you discover has barely left the house, because they've fallen into a depression and isn't acting like themselves as you've known them to be the last 15 years of your friendship.

Another one could be your hypothetical sister who is a social being that loves to be around people. You visit her one day and she is out of sorts, sitting in the dark, tells you she doesn't want company even though she invited you over and to leave her alone ad don't come back. When you see her the next week, she's feeling great, looking great, and you find out she just went out on the town with friends had a great night, drinking, dancing, staying out all night enjoying life. But when you see her the next week, you notice she's down again, doesn't want anyone around and isn't looking all that put together and she always looks great. You notice this pattern or something similar for a few months, it seems to be on rinse and repeat. Sometimes she's up, and when she is, she's maybe a bit too up, bordering on reckless, and when she's down, you're concerned about her well being because she seems nothing like herself, out of it in a way you're not familiar seeing her.

[ponchi101]

As always, very thoughtful comments.
But my question was: if the memories you recall ARE FALSE, would that make a difference in your therapy? That is what I have doubts about.

[mmmm8]

...

What I really don't understand from people who "refuse to believe" in psychoanalysis and/or actively try to refute it is why? What's the harm of other people benefitting from it (except potentially the cost), or even you trying it, if you think it does nothing. It's not like it's potentially dangerous and powerful like organized religion.

Txs for your post. I find it interesting.
Why refute psychoanalysis? For the same reason you want to refute homeopathy. Of crystal power. Or any other practice that in reality provides no curative benefits. If the entire premise of psychoanalysis, to the point of Freud's partition of the mind is incorrect, that area of research may be involving considerable effort that will achieve very little, because the foundation is incorrect and not based on reality.
About its potential dangers. Some classical psychoanalytical processes claim that sexual issues, which originally for them included sexual orientation, arise from conflicts that are really not there. I find this problematic, even if it has been corrected since (now accepted just as sexual orientation, not an "issue"). I also find that the edifice of parental relation regarding the children is wrong, as when it claims the theory of Oedipus/Elektra complexes, confusing child affection to his/her parent with a position that I believe is sick (sexual attraction to the parent).
Still gotta think more about this

I think the mental health profession has largely moved on considerably from Freud, at least in terms of where the analysis leads, if not some of the tactics of talk therapy

Moreover, unlike homeopathy, there are clear, well-documented strong positive results from therapy.

[mmmm8]

So, I HAVE heard the term psychoanalysis recently, from a psychologist with a PhD (not my therapist). But the definition is really quite loose now, essentially now it refers to the style of therapy/discussion used to arrive at helping people understand where they fit according to an approach used in psychology preferred by the therapist or person.

I find all of this quite fascinating and like the science behind it. Dry gave a great overview of what the spectrum of mental health issues and treatment looks like.

While psychology is not an exact science (psychiatry is more exact), I think about it kind of like physical therapy. Kinesiology is not really an exact science either, everybody's bodies are different and react differently to different manipulations/treatment. You can also find amazing physical therapists (I recently had a very bad back pain while on vacation and the random lady I went to fixed it completely in one session) and really bad ones (a professional masseur once gave me bruises for weeks).

Meanwhile, now that mental health issues are being measured, it's clear what a huge impact this has. 42% of Americans reported mental health issues last year. Even before COVID, something like 1 in 4 British people reported suffering from mental health issues at any one time (stats I know for work...).