A substantial portion of the people struggling with mental illness that I have spoken to recently seem not to understand the crucial importance of psychotherapy to their long-term healing. These are people who were prescribed medicine for their condition, and are now under the impression that faithfully taking their daily dosage will completely cure their illness.
Unfortunately, this a wrong and often dangerous perspective to hold. In fact, medication is often necessary, but it is not sufficient in helping a patient fight a mental disorder. Psychotherapy is equally important and can work beautifully alongside proper medication, yet this treatment is sometimes overlooked, misunderstood, or completely disregarded by uninformed clients. Below, I discuss the roles and goals of medical and psychotherepuetic treatment.
Understanding the Role of Medicine
The majority of common psychological illnesses should be addressed with prescription medication. This medication targets conditions in the physical brain in an attempt to alleviate the prominent and immediate negative symptoms of the disorder. Manic patients are likely to be uncomfortably energetic, delusionally optimistic, and a danger to themselves and their family. Depressed patients might be suicidal, or at least be suffering anhedonia, a-volition, and poor self-regard that stunt performance in their professional and personal lives. Anxious patients may find themselves completely unable to leave their houses, paralyzed by a fear of panic attacks in public. For these and other common mental disturbances, medicine is prescribed to lessen the presence of these dangerous symptoms and bring the patient back to a baseline of psychological health.
It is important to understand that the pressing symptoms of psychological illness are generally caused by a malfunction (or usually an interplay of malfunctions) of brain mechanisms. Very commonly, a problem with particular neurotransmitters (brain chemicals responsible for regulating mood and behavior) is occurring. Either the disordered brain is producing more of a particular neurotransmitter than it needs to, or it not producing enough (or is sucking the chemical back up through a process called ‘reuptake’ before it can have its intended effect).
Psychopharmacological drugs target the dysregulated brain activity that is believed to be causing the problem symptoms. The methods by which a drug accomplishes this goal are too numerous and varied for this discussion, but suffice it to say that the properly medicated patient is leveled off so that their lives are not constantly plagued by harrowing psychological suffering.
Recognizing the Need for Psychotherapy
There are two sides to every mental illness. There’s the biological symptoms we just discussed, and then there’s disordered cognitions (which is just a fancy way of saying irrational and maladaptive thought processes). Irrational thinking often contributes to the ongoing presence of the disorder, and in some cases may have caused the biological underpinnings to take hold in the first place. Thus, treating a client’s biology while ignoring his cognitions is like trying to patch up a leaking boat while continuing to sail it over rocks. If the problem is to stay fixed, you must solve both of the variables at work, and the latter is where psychotherapy comes into play.
Psychotherapy is intended to help your client identify what in his life disturbs him, and to find ways that to alleviate that hurt. Psychotherapy frameworks, practice, and goals are nearly as varied as their pharmacological counterparts, but the end result is always to help the client overcome the “thinking” aspect of their disturbance.
Readers of my blog know that I am partial to Cognitive Behavior Therapies, REBT in particular, in treating clients in this regard, however for the sake of this discussion it doesn’t so much matter because choice therapy should be made on the basis of whatever is most effective for the client. Thus, some people are put off by the active-directive nature of REBT and feel more comfortable in a traditional therapy setting where they are given free license to just talk, free-associate, and the like.
Using Both Therapies Concurrently
Regardless of the framework used, the fact remains that psychotherapy is intended to work hand-in-hand with medicine to help a client not just feel better, but actually become healthier psychologically. This involves ridding the patient of their biologically constructed symptoms, and then helping them to heal their psychological wounds and teaching them healthier ways to think about themselves and their world. The end result is a person who is now armed with a stronger psyche that can prevent relapses into illness by proactively using what he or she learned in psychotherapy to deal with their future disturbances.
The client who is only medicated on the other hand is left cognitively bludgeoned, and may never heal the cognitive problems that engender their biological symptoms and foster their recurrence.