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  • 0 NP0015 21st-Century Trauma TreatmentNP0015, Trauma, Session 4, Ken Hardy 02.29.2012 14:11
    Excellent. Thank you immensely!
  • 0 NETWORKER EXCHANGEThe Decline of Big Pharma and the Rediscovering of Psychotherapy 12.28.2010 14:05
    Then perhaps those clients were not diagnosed properly. For if one is truly clinically depressed, medication will not "numb you up", in fact, if you don't need it, it won't do much of anything at all---even if anxiety-disordered, if the right medication and dose is prescribed, it will not "numb you up"---and for those who have ADHD (and here I will speak about adults with ADHD), it can severely impact their professional lives and also personal lives. Why would medication be withheld? Why would it not be tried first thing unless the patient doesn't want it? When a person with adult ADHD is given meds for ADHD (if they will take medication) they will NOT respond as if on speed. IF they do, they've been incorrectly diagnosed. An adult with ADHD will find the right med (and dose) to be soothing (NOT stimulating) and will be able to focus in a consistent way, even if the task is something they do not like (ie, a task at work that must be done that they would have much difficulty with otherwise.)

    To say that "no medication can provide that" and (re: skills so "they can learn to live again" seems to miss the point I made earlier---the brain is just as "medical" as the knee, as the heart, as the kidney, liver, etc.--it's the executive center!

    Who would tell a person who has a severed ACL in their knee to cope with it by walking more slowly, by avoiding sports, never skiing again, etc? For that's what it would take and this could be done. If someone is adamantly opposed to surgery they can limit themselves and NOT have an ACL reconstruction. If an ACL replacement IS done (which involves surgery which we all know is high risk--surgery always is) then all of the activities that were done previously can be done again---there need not be coping skills "taught" where a person has to learn how to live again with a ruptured ACL in their knee. I watched my husband at age 40 try to do just this as his doctor said...that he was too "old" to require an ACL reconstruction (ie, he was not a professional athlete, etc.) This was all bunk. My husband had an ACL reconstruction with PT after and within a year could do anything he could do before, to include running, skiing, tennis, etc. without his knee going out on him.

    I think we sell our patients short (or border on malpractice) when we don't give them the option of medication when the medication will treat a medical mental illness. This said, I think there are many therapies and a reason for that. But we do best to be wise and not married to any one pet theory or treatment---or we might treat our patients poorly and short-change them.
    Again, I fear that diagnostics are not being taught in an integrative way anymore. Clinical major depression, unipolar and bipolar depression are NOT "sadness"or coping problems, and are not due to a "lack of coping skills"---clinical depression is a medical illness and deserves the right to be recognized as such! If you get pneumonia you don't want to be instructed in "how to breathe."
  • 0 NETWORKER EXCHANGEThe Decline of Big Pharma and the Rediscovering of Psychotherapy 12.24.2010 18:18
    Back in the day when practices actually had an integrative approach (with psychiatrists, clinical social workers, psychologists, family therapists, etc. all in the same practice)---things were far different than today. I see the mental health system today as fragmented and often doing a disservice to clients and to practitioners.

    Re: depression---if it is clinical (chemical) then medication can be extremely helpful (or if it is major depression with psychotic features then why would meds be withheld?) And why would meds be withheld except in the worst case scenarios? Sometimes meds are pretty much all that's needed (after education about these meds and the clinical depression is discussed--short term supportive therapy), sometimes meds and a lot of psychotherapy are both needed, sometimes meds and CBT are the ticket, or psychotherapy alone, etc.

    If the diagnostics are off, then the treatment will be also. What bothers me today is that with the fragmentation of care, I think the diagnostics are quite often off. Then it doesn't matter what is done, it won't be of help in the way it can be.
    Just tossing scripts at patients can be a problem, doing only psychotherapy (and being married to that position) or only CBT can all be problematic, I think.
    I've seen unipolar and bipolar depression be misdiagnosed as schizophrenia or borderline, I've seen meds given when they weren't needed and another type treatment was, I've seen CBT used only when the practitioner is versed just in that treatment or mainly in that treatment, I've seen patients in psychotherapy who were classic ADHD who did need meds go without them for far too long, spending too much time and money in psychotherapy.
    The bottom line to me is being a top-rate diagnostician first and foremost. If that not gotten right, then forget the whole thing. If the diagnostics are right (or close as they can be at this time) and an integrative approach is taken, then we all do better.

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