You are so much more than your psychiatric diagnosis


13 May
13May

As a country, the U.S. has created a paradigm, a way of looking at mental health as a bag of diagnoses.  Mental health professionals like myself call it the 'medicalization' of counseling and psychotherapy.

I'm not going to criticize that paradigm, but I'd like to remind you there are others.  What is one of the downsides of this paradigm?  I don't relish reducing my clients to a diagnosis (or two). But it's how our health care system categorizes problems and pays for it's services.  The current system is good at dealing with what is in front of it.  The surface.

However, I've always 'felt' this medicalization wasn't the whole story and even more importantly, wasn't my preference.  Yes, I have to live within that system, but only to the degree I must to survive as a business person.  You must, as a consumer, recognize the compromise you are making to get the care you need.

I like to look deeper when working with my clients.  Symptoms are easier to treat and that is what medicine does.  But treatment of symptoms is often just a bandaid.  Then again, yes, you have to stabilize someone enough to be able to work most effectively with them.  If they are so depressed for example, that they can't use their therapy sessions well, getting at that symptom can be very helpful.  I am not one, for example, to trash medications for that very reason.  

And to be completely transparent: I too have benefited both in the short and long run from psychotropics.  And have seen many clients benefit as well.  So despite the negative press, medications are doing a lot of good in the real world, despite their risks.

So what am I saying?  I like having a mix of options to help my clients.  After all, the end goal is 'what works for this person?'. That's all that matters.  So while I like to go deeper, beyond the surface, I've also been successful at finding more time sensitive ways of helping my clients.  

I was trained in the 1980's when the mental health system was really starting to look at the cost and effectiveness of the care we were delivering. Most of this is a positive development if you ask me.  Remember managed care? Yes. One of the good experiences I gained from that time and that training was that therapy should show positive outcomes.  You see, there was a time prior to managed care where there were abuses of the system. Psychoanalysts by definition charged hundreds per session (I guess because their training took so long?) and it 'took years' to 'fix' a client, if you ever did!

Luckily, I was trained in a more positive and practical framework: positive psychology and brief and solution-oriented methods.  I was trained to focus on what was 'going right' and look for more of that.  And then build upon the positive. To me, the over focus today on CBT (cognitive behavioral therapy) is again more of a 'medicalized' framework: as in 'cut out' the negative or 'bad' thoughts and replace them, much like a surgeon would cut out a diseased part of you.  Again, CBT isn't all bad.  In fact I use a variant of CBT I like more: RET - rational emotive therapy.

I also notice that as we as a profession become more 'medicalized' we tend to again - reduce - and look at people from a diseased or 'weakened' framework.  Perhaps this is the source of people now becoming too focused on 'being triggered' by others and such.  Like on college campuses.  I know I might be criticized for that view point, but I do think there is something to that thought.  I am not that thought, I am just sharing my observation that going down this 'sickness' or 'I am weak' road may not be good for our youth, who need to become as resilient as they can (without becoming part of the problems out there) to get along in the world after graduation.

Enter positive psychology: one of it's tenets is looking at mental wellness as something available to anyone, no matter how awful their past.  This has been borne out in studies: many people with horrible pasts turn out incredibly well and others with lovely pasts become criminals, for example.

The bottom line as a society is that therapists are accountable too.  We don't have endless sums of resources to pay professionals who don't help their clients get real and hopefully - yes lasting - results.  Yes, that is incredibly subjective.  But if you've been doing analysis with someone for 5 years and they still can't work, love or play in the world, I'd say I need to know more.

Lastly, one of the exciting developments I notice happening in the past few years or so is that more attention is being given to therapy and to therapists.  How vital they are.  This is good for the field.  We need to continue that development so our best and brightest are more interested in becoming therapists.

As we move into the future, society is starting to fully appreciate how vital mental wellness is and to not just give that lip service (or worse yet ignore or stigmatize it).  

EVEN BETTER:  Let's work to create a LESS medical-ized, MORE strengths-based treatment system, so that more will be drawn to getting the help they need within it!




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