William Hankin, MD
Whatever kind of problem you have, there is a therapy out there that may be right for you. The task is in navigating the options that exist and choosing the right path. As many self-help books as you can find, there are nearly as many different kinds of therapy that are designed to help you make the change you are seeking. This is a good time to review some of the modalities you might encounter.
Let us first exclude physical therapy, acupuncture, aroma therapy, and their distant cousin chiropractic treatment. These professions focus on physical problems. It is true that there may be psychological components that get better as well, but these practices deal primarily with problems affecting the physical body in contrast to mental health providers.
In the spiritual and mental domains, there are faith healings, religious experiences, general counseling about life problems and the various psychotherapies that exist in our society. If you have faith in charismatic cures, you are likely already well-aware of where to go and seek that kind of help. There are all kinds of counselors; job counselors, life coaches and others. But let us try and narrow down the discussion to the various psychotherapies that are currently offered to treat mental and behavioral health concerns.
One of the first forms of psychotherapy was hypnosis developed in the treatment of hysteria, an antiquated term for disorders of the mind. This technique is still used to work with motivated behaviors such as smoking and overeating, pain treatment, anesthesia, and to treat traumatic experiences. However, Freud found that hypnosis wasn’t very effective at treating other forms of mental illness. Therefore, he developed what became known as psychoanalysis.
Psychoanalysis, as developed by Freud and several of his students who branched off on their own, involved a patient sitting (or lying) in a room with the analyst who listened to their stream of consciousness, all the while conjecturing about their unconscious mind. It was believed the unconscious motivations of the ‘id,’ the ‘ego’ and the ‘superego’ accounted for the patient’s problems in their lives. The therapy consisted of uncovering these unconscious mechanisms, which often had to do with presumed sexual issues, and freeing the patient from their constraints. Psychoanalysis started out as a practice of doctors, first with Freud, a neurologist by training, but today it is also practiced by non-medical degreed individuals. It is usually expensive, consisting of multiple sessions per week lasting months and even years. It has been a trend for writers, movie stars and other Hollywood professionals to undergo psychoanalysis, something that had such an impact that psychoanalysts and other psychiatrists are frequently film antagonist such as Hannibal Lecter.
After psychoanalysis came a trickle and then, ultimately, a deluge of different psychotherapies. There was gestalt therapy developed by Fritz and Laura Perls. It was an outgrowth of psychoanalysis or the therapy of the “here and now” based on the idea of experiencing life in the present. Jung developed a therapy based on analysis but focused on the idea of the “collective unconscious” and used Buddhist-like mandalas as inspiration.
In the past 40 years, various other talking therapies developed including existential therapy, cognitive-behavioral, rational emotive and interpersonal psychotherapy. You can find practitioners of these therapies, usually in university hospital settings in large cities, but also locally in non-academic or hospital settings. If you want an exhaustive list of different psychotherapies, web searches will provide a list. How can you choose just one?
In point of fact, most people do not usually choose the therapy, but they choose the therapist. The first therapists were shamans, priests and then doctors. They dealt with life and death issues and people went to them for advice. When it came to mental illness, primary providers were doctors going back to the days of Hippocrates in ancient Greece. Family doctors today are often the first ones to treat depression and anxiety. More serious conditions are referred to psychiatrists. Outside of the medical world are psychologists and social workers who provide various forms of non-medical treatment or counseling. Other therapists are licensed counselors, marriage and family therapists and pastoral counselors who are even further away from the medical model.
That is not to say that all psychiatrists only prescribe medication, which is the limited practice of psychopharmacotherapy, many offer different forms of psychotherapies as a part of the services they provide. One of the early non-Freudian psychiatrists was Adolph Meyer who spent much of his time at Johns Hopkins. He believed in knowing the whole person. He treated the various psychiatric diseases and also worked with other troubled patients to solve problems. He has been credited with inventing the field of social work with the intent to establish adjunct mental health workers to go out in the community and learn about the conditions of the patient in their home setting and to report back to the team in the hospital.
One quality that can be said of all reputable therapists is a strong passion and desire to help people in need. As psychiatrists, we in the New Jersey Psychiatric Association trained first in medical school and became doctors. We were prepared to approach the whole person. We understand the full range of medical problems and their potential impact on a person’s physical and mental wellbeing. Then we had four or more years of advanced specialized training in the normal and abnormal aspects of the brain and mind during residency and various fellowships. We use the combination of medicine and psychotherapy to help the patient overcome their mental and behavioral health problems all while incorporating our medical knowledge of the body and the patients systemic physical health. Some of us practice psychoanalysis in its various forms, but all of us are enlightened and committed to our continual study of both physical and mental health and wellbeing.
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