Psychotherapy oriented Residency Programs??

First off, examine the sources of this material a bit more carefully.
Were you also trying to say this and this in your previous thread?
Citing an "abridged", unattributed article from what is clearly an anti-psychiatric site does nothing to move you or anyone else toward a psychotherapeutically-informed practice of psychiatry.

OldPsychDoc said:

First off, examine the sources of this material a bit more carefully.
Were you also trying to say this and this in your previous thread?
Citing an "abridged, unattributed article from what is clearly an anti-psychiatric site does nothing to move you or anyone else toward a psychotherapeutically-informed practice of psychiatry.

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OUCH.

OldPsychDoc said:

First off, examine the sources of this material a bit more carefully.
Were you also trying to say this and this in your previous thread?
Citing an "abridged", unattributed article from what is clearly an anti-psychiatric site does nothing to move you or anyone else toward a psychotherapeutically-informed practice of psychiatry.

Click to expand...

HOLY COW, THIS IS HILARIOUS!!!!!!!!! Just by looking at this poor patient, this guy could tell that he had a "deep habit of masturbation." I hope this guy never comes across me--who knows what he'll think?😀

It's ironic, too, that somebody who seems to have some degree of contempt for Western medicine is so eager to try to help cure this patient, who wishes to become an MD.

"Sages and monks of ancient India had ruled that medication could be fully successful only if proper dietetic, physical and mental control is adhered to. The same is prescribed for maintaining a healthy mind and body. Sexual activities shake and stir both body and mind. Hence it should be avoided for prompt and proper cure of any ailment and to keep a balanced mind and body. Unnatural and artificial mode of sexual satisfaction is more dangerous.

The case of a medical student is very pertinent in this context. Having completed graduation in B.Sc. in top rank, he was selected to the MBBS course at medical college Kottayam. He joined the college for his course and stayed in the Men's hostel. He stood top in the first year examination. Later on in the third year he appeared to be dull and weak in studies and activities. He became feeble. He could not concentrate. He was in a state of despondency. He thought of discontinuing his studies. Finally he met the neurologist at the college hospital. His ailment was diagnosed as depression. Though it was a case of psychiatry, considering the future of the student, the neurologist took up the treatment to avoid a stigma. He was put on various neuroleptic and psychiatric drugs and the treatment went on for months together. The young man became more and more depressed and feeble. At last he came to the conclusion –discontinue the study and bid fare well to the medical college for good. It was the period when a journalist in the periodicals, published write-ups on the treatment at my centre. [The common people misjudged the illusory personality in the case histories of the write-ups, as diabolic possession and the treatment as exorcism, and myself as an exorcist] Some of his friends advised him "See, we cannot rule out the possibility of some evil done to you under sorcery. You have been very good at studies. Enemies of you and your family might have done something to destroy your career. You must see Fr. Geo"'. He came to me. A young man emaciated and gaunt –with no vigour, charm and pleasantness sat in front of me in the counseling centre.


My first look at him, his emaciated facial appearance, convinced me of the sign and symptom of his deep habit of masturbation. In the counseling room I disclosed him of my findings, enumerating the symptoms of his sickness before he started speaking of it. This created an impression of belief in me. He admitted every thing. He said he was unable to control his sexual feelings. I advised him ways and means to control his feelings and to be fully occupied at all times to reach his goal.of studies, to become a doctor, the ambition of his life. He promised to follow the directions. Herbomineral {Ayurvedic} medicines to stimulate his nerves and regain his lost vitality were given. He was asked to see me after one month. On the 30th day he was the first to meet me. He was very happy and joyful. He was full of gratitude and thanked me for helping him. He said he could cope -up with his studies and concentrate well. Herbomineral stimulants for two weeks more were given. I asked him not to retreat from his decision and fall back again to the bad habit of self-abuse any more. After about an year he came to me once again. This time I could not recognize him. He was very pale and feeble. He said "Father please help me. I have slipped into the habit of self-abuse. I cannot concentrate in my studies. My friends are ridiculing me. I dare not to face them. I feel inferiority complex. I cannot look at the face of any woman. I have no interest in anything expect masturbation. I find solace and satisfaction only in this deed. I had some domestic problems, which made me depressed. This time I consulted another neurologist." On my repeated questioning as to why he deviated from my earlier direction and relapsed to the habit, he said "it happened so" ."

Come on, the OP has 7 posts to his/her credit... Let's not feed the troll, we have such a good family here 😉

I'll give the OP the benefit of the doubt here and actually answer his question...

I think you'll be hard-pressed to find a residency that doesn't value biologic psychiatry. My impression is that in general, the field is moving towards more integration between brain-based psychiatry and psychodynamically rooted pscyhiatry. You'll want solid training in both to be the most effective psychiatrist you can be. Most studies show that a combined approach is the most efficacious treatment for most psych disorders. You might want to check out this article - I think it should be required reading for all med students, and I think it offers a great framework for thinking about how biology and psychodynamics intersect:

http://www.hss.caltech.edu/~steve/kandel.pdf

That being said, of the programs I interviewed at (NYC and Chicago programs only), Cornell, Mt. Sinai, and Northwestern impressed my as the most psychodynamically oriented.

While I do not agree with the OP's attached article, I was wondering if someone more knowledgeable and intelligent than myself could articulate some empirically sound and coherent arguments refuting a few of his points/claims. Like I said, i don't agree with alot of it, but cant really put together articulate rebuttals at the moment. Here are the excerpts I was most interested in:

[FONT=verdana,arial]1. "So what are the limitations of biologic psychiatry? First of all, medications lessen symptoms, they do not treat mental illness per se. This distinction is crucial. Symptoms by definition are the surface resentation of a deeper process. This is self-evident. However, there has been a vast and largely unacknowledged effort on the part of modern (i.e., biologic) psychiatry to equate symptoms with mental illness. .
[FONT=verdana,arial]For example the illness major depression is defined by its set of specific symptoms. The underlying cause is presumed to be a biologic/genetic disturbance, even though this has never been proven in the case of depression. The errors in logic here are clear. A set of symptoms is given a name such as major depression, which defines it as an illness, which is then treated with a medication, despite the fact that the underlying cause of the symptoms remains completely unknown and essentially untreated.".....[FONT=verdana,arial] "Thus, mental illnesses are equated with symptoms. The surface is all there is. The perverse beauty of this scheme is that if you take away a patient's symptoms, the disorder is gone.".
[FONT=verdana,arial]
2..[FONT=verdana,arial]"Unfortunately what I also see these days are the casualties of this new biologic psychiatry, as patients often come to me with many years of past treatment. Patients having been diagnosed with chemical imbalances despite the fact that no test exists to support such a claim, and that there is no real conception of what a correct chemical balance would look like." .

DrWuStar said:

I'll give the OP the benefit of the doubt here and actually answer his question...

I think you'll be hard-pressed to find a residency that doesn't value biologic psychiatry. ... That being said, of the programs I interviewed at (NYC and Chicago programs only), Cornell, Mt. Sinai, and Northwestern impressed my as the most psychodynamically oriented.

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Don't forget that not ALL psychotherapy = psychodynamic psychotherapy.
There are places, such as Penn, where cognitive-behavioral therapies are taught as well.

I'm not sure about the "small city" piece the OP is seeking. Most likely he should seek a community-based program where he can find mentoring in his chosen school of therapy.

erg923 said:

While I do not agree with the OP's attached article, I was wondering if someone more knowledgeable and intelligent than myself could articulate some empirically sound and coherent arguments refuting a few of his points/claims. Like I said, i don't agree with alot of it, but cant really put together articulate rebuttals at the moment. Here are the excerpts I was most interested in:

[FONT=verdana,arial]1. "So what are the limitations of biologic psychiatry? First of all, medications lessen symptoms, they do not treat mental illness per se. This distinction is crucial. Symptoms by definition are the surface resentation of a deeper process. This is self-evident. However, there has been a vast and largely unacknowledged effort on the part of modern (i.e., biologic) psychiatry to equate symptoms with mental illness. ....

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I think the same point could be made about a "purely psychologic" psychiatry--isn't the writer implying that the "symptoms" are "caused" by some "deeper process" that must be elucidated through therapy? I agree--our "pathophysiology" in psychiatry is weak, weak, weak--but there's growing evidence that these symptoms have biological origins, whether genetic, developmental, environmental, or a combination of the above. We are a young science. Diagnosis and treatment are still evolving, and are still phenomological and categorical in nature, as opposed to being clearly associated with a specific physical findings. This has to do with the complexities of human behavior, the still poorly understood intricacies of brain functions, and the multifactorial uniqueness of individual experience. I think that good biological psychiatrists DO understand this--that the individual narrative is important, that specific symptoms have different meanings to different individual patients.

Articles like this often seem to look at one segment of patient population--say moderately depressed individuals with poor coping skills and issues of childhood trauma or deprivation--and accuse us of "just treating the symptoms" instead of somehow resolving the past injury. I've never seen a writer like this suggest that schizophrenia or bipolar mania was somehow explicable in these terms, or that we shouldn't use medications to stabilize dangerousness in these patients. I think this article excessively polarizes the "biological" vs. "psychological" dichotomy. Perhaps this distinction is meaningful to a handful of dogmatic theoreticians, but for those of us in the real world, taking care of real people, we know they're just different ways of talking about the same thing.

erg923 said:

2.[/SIZE].[FONT=verdana,arial]"Unfortunately what I also see these days are the casualties of this new biologic psychiatry, as patients often come to me with many years of past treatment. Patients having been diagnosed with chemical imbalances despite the fact that no test exists to support such a claim, and that there is no real conception of what a correct chemical balance would look like." .

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I hate the term "chemical imbalance", for just that reason--it implies that we know specifically what's going on, when we don't. However, I think the term has been useful to give comfort to patients who do need to see that their depression is a medical disorder, not a moral failing. I prefer to talk more in terms of having problems of "disordered brain function" (which is also admittedly a bit hand-wavy). I might say things like: "Your moods are supposed to respond to normal ups and downs of life, but now they're all messed up. The areas of your brain which regulate your sleep and appetite aren't working the way they should. You don't feel the enjoyment of life that you should. Your energy is low. Your movements might even feel slowed down. Your sense of self-preservation is even impaired. We don't know exactly why, but we've seen that other patients with these symptoms usually start seeing improvement in these areas when we try medications which change the activity of brain chemicals--neurotransmitters--like serotonin, dopamine, and norepinephrine." This way I try to emphasize that we are working on target symptoms, which can be observed, and de-emphasize the idea that "your serotonin is low"--which is a gross misstatement.

erg923 said:

[FONT=verdana,arial]1. "So what are the limitations of biologic psychiatry? First of all, medications lessen symptoms, they do not treat mental illness per se. This distinction is crucial..

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I think the easiest rebuttal to that point is this:

[FONT=verdana,arial]"First of all, psychotherapies lessen symptoms, they do not treat mental illness per se. This distinction is crucial."

The idea that psychotherapy somehow cures mental illness while medications just mask symptoms doesn't make any sense, unless you deny the fundaments of the biopsychosocial model. Why is it somehow a good idea to only address the psychological elements of an illness that contains biological, psychological, and social components? For some patients, and certainly many less ill ones, that might make sense. But not everybody that comes into the ER with a belly ache gets an appendectomy.

There's nothing magic about medications. There's nothing magic about psychotherapy.

But there's certainly a lot of magical thinking on the anti-psychiatry sites.
.

Don't forget that not ALL psychotherapy = psychodynamic psychotherapy.
There are places, such as Penn, where cognitive-behavioral therapies are taught as well.

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EVERY place should teach cbt as well as psychodynamics, ipt, group, etc, and each should preferably be taught by experts in the specific area.

At the least, psychodynamics can teach ways to create an alliance and develop the ability to recognize and work with resistance, since resistance affects other treatments.

From my perspective, the idea that depression is "caused by" a chemical imbalance is fatuous, as is the belief that our medications are--by themselves--effective treatments. If you think they are, check out their success rates--and these are success rates generally defined as a reduction of symptoms in a very pure, compliant population (i.e, they are not "cures" and don't even apply to most patients). For almost every illness and population, treatment works best when therapy and meds are judicously combined. To just give meds reflects the profession's denial of reality and its abrogration of a core responsibility.

The only people who are pleased by psychiatrists becoming pill pushers are a)cost-cutting insurance companies; b)pharmaceutical companies, almost all of which have devoted their research money into me-too drugs and self-serving effectiveness studies that advance the science not a whit; and c) psychiatrists who don't know how to do therapy.