One Size Does Not Fit All
Dr. Kevin (a physician blogger) recently wrote that he is concerned about how certain approaches to medication are being related to patients. I agree with him. We are complex creatures and the one size fits all approach to treatment just doesn't fit at all.
I see this on my message board where I respond to questions on anxiety and panic more times than I can count at this point. Searching for a quick answer to relieve their symptoms, affirms that patients and physicians, too, can engage in simplistic thinking.
There's nothing simple about anxiety, panic or depression. It's not as simple as a chemical imbalance and treatment requires skill on a number of levels. First, there is the skill to adequately assess the level of one or more of these disorders. Next, there's a need to know the patient and what will or won't work with them. This requires a good working relationship with the patient and a true partnership is an absolute necessity. Patients or physicians working at cross odds or not really listening to each other can result in poor response to treatment.
I visited a dermatologist the other day. He is an extremely skilled physician and, as I know and his nurse said to me, "When he's with you, he's with you." That is my kind of a physician. He has also made it a point to explain to patients all the possible treatments for any condition, what is involved and how long it will take. What's more, he encourages questions and provides materials to read. There's never a rush.
I understand that many patients find it difficult to accept that they have something that has anything to do with a mental condition and they want to get it remedied right away.
The research into the most effective treatments for anxiety, panic and depression all points to a combination of cognitive therapy and medication, when needed. They've looked at one treatment and both treatments combined and the results all point to a two-pronged approach. The quick fix isn't it.
This does not mean that a patient has to feel they have to bare their soul when they go into therapy because cognitive therapy focuses on problems and solutions, not early toilet training. It's a therapy that should be symptom-oriented, usually short in its course and leave the patient with new tools to use on their own to handle anything that comes up in their lives.
Some members of my board have indicated they've had no success with therapy and I answer that it may have been because they went to someone who either didn't specialize in their disorder or didn't practice cognitive therapy. Yes, you could say I have a preference here, but it's to one I know works and works well.
Related Topics: Therapy as Good as Drugs for Depression, The Art of Self-Examination
I see this on my message board where I respond to questions on anxiety and panic more times than I can count at this point. Searching for a quick answer to relieve their symptoms, affirms that patients and physicians, too, can engage in simplistic thinking.
There's nothing simple about anxiety, panic or depression. It's not as simple as a chemical imbalance and treatment requires skill on a number of levels. First, there is the skill to adequately assess the level of one or more of these disorders. Next, there's a need to know the patient and what will or won't work with them. This requires a good working relationship with the patient and a true partnership is an absolute necessity. Patients or physicians working at cross odds or not really listening to each other can result in poor response to treatment.
I visited a dermatologist the other day. He is an extremely skilled physician and, as I know and his nurse said to me, "When he's with you, he's with you." That is my kind of a physician. He has also made it a point to explain to patients all the possible treatments for any condition, what is involved and how long it will take. What's more, he encourages questions and provides materials to read. There's never a rush.
I understand that many patients find it difficult to accept that they have something that has anything to do with a mental condition and they want to get it remedied right away.
The research into the most effective treatments for anxiety, panic and depression all points to a combination of cognitive therapy and medication, when needed. They've looked at one treatment and both treatments combined and the results all point to a two-pronged approach. The quick fix isn't it.
This does not mean that a patient has to feel they have to bare their soul when they go into therapy because cognitive therapy focuses on problems and solutions, not early toilet training. It's a therapy that should be symptom-oriented, usually short in its course and leave the patient with new tools to use on their own to handle anything that comes up in their lives.
Some members of my board have indicated they've had no success with therapy and I answer that it may have been because they went to someone who either didn't specialize in their disorder or didn't practice cognitive therapy. Yes, you could say I have a preference here, but it's to one I know works and works well.
Related Topics: Therapy as Good as Drugs for Depression, The Art of Self-Examination
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4 Comments:
Hello Dr Farrell;
Enjoyed your blog. I agree the 'one size fits all' approach to treatment is flawed thinking. But thinking that CBT works for everyone as also flawed. When it doesn't work the match between the patient and the therapist is always named as the reason why.
I find it unprofessional of you to make a demeaning and haughty comment about 'early toilet training' in reference to deeper therapies that are proven to be helpful to many. I realize the comment was made to put people at ease about what therapy is and isn't about and that the patient is the one who decides what to talk about and when, but by making that statement, you yourself seem to be engaging in simplistic thinking and advising a 'one size fits all' approach.
Anxiety and panic and depression can have deep roots that I believe are important to identify and resolve in order to get long-term relief. CBT can be something to do along the way, but it is a band-aid in my opinion and experience.
There is too much focus on medications these days for all health issues. In my opinion and experience, medications are band-aids also.
I'm worth the time it takes to look deep. I'm willing to experience what I need to in order to better understand myself. It is a journey of discovery I want, not a download of the latest 'tricks' to try (my opinion of CBT and REBT).
Thanks for the blogs! I like to read what you say whether we agree or not!
My apologies, Dr. Farrell;
I have been to your website and see you are not anti-psychodynamic therapy as I was believing when I read your blog and responded as anonymous. I apologize for saying you were unprofessional in your comments. I was judging without all the information.
I still maintain my opinions based on my own experiences and I still maintain that CBT is not for everyone either.
Sometimes it is hard to define just what makes a good therapy session from the patient's perspective. I have left a session with a storm cloud hanging over my head and a feeling of doom for no apparent reason as well as with a feeling of lightness and peace for no apparent reason. Sometimes it is simply connecting with someone in a pleasant and completely unprofound way, I believe.
Thanks again for your blogs. And for letting me have my say.. twice now since I could not let my original comments stand.
~Tasker
I meant to say CBT, CBS; didn't mean to indicate that TV was therapy, although it can be useful as can films and books.
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