The Necessity of Psychotherapy

Years ago I wrote an essay about the death of psychotherapy. While I did not state that psychotherapy is currently dead, I did state that much of it might die in the wake of advances in understanding the neurobiology of psychological disorders. It will take decades for these advances to occur (if they ever do) so this post will now serve to balance my post from years ago.

I’m going to start with a story about two people (these are based on real events but names, situations, and identifying details have been changed to protect confidentiality). Jim was convicted of a violent crime and spent a number of years in prison. He was required to attend treatment throughout his years in prison – anger management and other therapies. He had a history of alcohol and drug abuse. A while after he got out of prison, he started therapy again to help him through some difficulties, including his experiences with homelessness. Jim was a very pleasant person to interact with; he was well-read and insightful. He was trying to improve his life.

The second person was named Frank. He was also homeless but was staying with a friend. He had past drug and alcohol abuse but had been free from drugs for about a year. He was anxious, paranoid, and not the most pleasant person to interact with. He had never received treatment for depression, which he experienced chronically and severely. He exhibited little insight into his problems. He thought the negative events in his life were all someone or something else’s fault.

The first patient had learned a lot from his psychotherapy over the years. The second never had therapy. While they were very different people, they experienced similar challenges and psychological issues over the years. Without disregarding individual differences, the patient who had had years of therapy had a lot of insight and self-knowledge but the other patient had very little.

Jim had been a violent man but over the years and through therapy, he learned a great deal of self-control and restraint. Psychotropic medications could not have taught Jim this. For him, psychotherapy was highly successful. Without out it he might not have been the pleasant person that he was.

Therapy teaches you skills; it gives you tools to deal with maladaptive thoughts and behaviors. It allows you opportunity to sort through your experiences and thoughts in a safe place. It allows to to talk to someone else without being judged. Therapy is thus treatment and education. It can have as strong or stronger effects on mood and behavior as medications and the benefits can last longer. Understanding biology is necessary to understand behavior but it is not sufficient to explain all behavior, at least not with our current knowledge. Will we ever had sufficiently advanced knowledge of neuroscience and biology to no longer need psychotherapy? I don’t know but if we do, it won’t happen for many years.

The Woman on the Bus

Yesterday I was riding the bus to campus and sat across from a woman with obsessive-compulsive disorder. At least, I believe she had the disorder. For at least 10 minutes she combed her hair in one spot on the back of her head. Over and over and over she combed. Occasionally she would switch hands but she kept combing for about 10 minutes. Then she stopped. It was so interesting to see these compulsions in real life. I’ve seen them in videos and read about them but hadn’t yet seen them in real life. It’s possible that she was just combing her hair or that she had a tic disorder that manifested itself through combing over and over but it sure looked like OCD. I really felt sorry for her. Sorry isn’t quite the right word but OCD is not easy to deal with. She didn’t even look like she really was paying attention to what she was doing – her movements were so robotic. Anyway, that was one interesting experience yesterday.

An introduction to paranoid schizophrenia

Schizophrenia is a common (1% prevalence worldwide) and commonly misunderstood psychological disorder. Below is a link to a slide presentation I made about paranoid schizophrenia that I used in one of my classes. It is by no means comprehensive but should provide a decent introduction and overview of current beliefs concerning schizophrenia. Feel free to view it (Acrobat Reader is needed) for personal information but the material is copyrighted and is not intended for non-personal use. Please contact me if you would like to use some of the information for non-personal use.

Paranoid Schizophrenia slides

Also, here is a link to a pretty good video explaining schizophrenia: Video link