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I have a presentation to give, this week, on why patients get better. I have attempted to start this, but I cannot find a good starting point. Anyone have any ideas?
Why patients get better
- Thread starter Abram Hoffer
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Define exactly what is "getting better".
That's the first step.
That's the first step.
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Regression to the mean?
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I agree..depends on what group of patients you are talking about, and what the definition of "better" is? That said, from a psychotherapy standpoint...."The Necessary and Sufficient Principles of Therapeutic Change" by Carl Rogers circa 1956 is a classic. Great paper. Sufficient? Well, probably not. Lots of research has come out since 1957. But many still regard them as necessary. Nancy McWilliams from Rutgers writes heavily on this topic, and the topic is also heavily discussed by Larry Buetler. Overall, studies show that about 70% of the variance in psychotherapy outcome is attributable to the quality of the relationship between clinician and patient. Nothing more. Kinda makes you wonder what all the fighting is about sometimes doesn't it.......
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I love that people stop to think about these types of fundamental questions.
We have talked about issues like this at my program. What role do meds and psychotherapy have acutely and in the long term? Do we really help patients? Are the meds the most important part? We spend so much time debating and changing them. Or do psychosocial factors and supports really make a big difference?
I guess the easy (or hard?) answer is, we really don't know. One prestigious faculty member talks (and I love to listen!) about how he feels the meds are a very small part. Basically, just pick one or some and then focus your time on therapy and psychosocial supports, because they are more likely to make a difference. In the end, it can be quite frustrating because many patients simply won't get better and often get worse, or get obese, diabetes, tardive dyskinesia, etc.
We discussed long term outcomes in psychiatry. One research project supported by our department is studying a very unique population of schizophrenia in the South Pacific. The above named faculty member believes the data coming from this study will show no difference in long term outcomes between twin pairs, in which one was treated with meds and the other was not. This is really a tough thing to swallow if you think about it. What will we be doing for treatment in 20, 30, 40, 50 yrs from now?
We have talked about issues like this at my program. What role do meds and psychotherapy have acutely and in the long term? Do we really help patients? Are the meds the most important part? We spend so much time debating and changing them. Or do psychosocial factors and supports really make a big difference?
I guess the easy (or hard?) answer is, we really don't know. One prestigious faculty member talks (and I love to listen!) about how he feels the meds are a very small part. Basically, just pick one or some and then focus your time on therapy and psychosocial supports, because they are more likely to make a difference. In the end, it can be quite frustrating because many patients simply won't get better and often get worse, or get obese, diabetes, tardive dyskinesia, etc.
We discussed long term outcomes in psychiatry. One research project supported by our department is studying a very unique population of schizophrenia in the South Pacific. The above named faculty member believes the data coming from this study will show no difference in long term outcomes between twin pairs, in which one was treated with meds and the other was not. This is really a tough thing to swallow if you think about it. What will we be doing for treatment in 20, 30, 40, 50 yrs from now?
