Thursday, September 30, 2010

Questions about psychotherapy

Henry A. Nasrallah, MD

As a National Institutes of Health-trained psychopharmacologist who also received substantial psychotherapy training during residency, I value both as pillars of psychiatric practice.

However, often I think about the evidence-based conduct of psychotherapy, which I regard as a neurobiologic treatment similar to drug therapy, and then I ask research questions that remain unanswered, such as:

  • What is the therapeutic “dose” of psychotherapy? Does it differ by type of therapy or the patient’s diagnosis?

  • Is the dose measured in the number of sessions or the time the patient is in a therapy session? Is there a loading dose? What is the maintenance dose?

  • What is the optimal schedule for psychotherapy? By what established criteria does a therapist determine how often to administer psychotherapy? Why weekly and not daily? Why not 2 or 3 times a day intensive psychotherapy for acutely ill patients? Is the scheduling based on the cost to the patient, the therapist’s availability, or insurance coverage rather than the patient’s needs?

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1 comment:

  1. Some answers:
    -Indication for a given psychotherapy: If the only tool you have is a hammer...
    -Best time of day: bedtime, if the psychotherapist suffers from insomnia.
    -Psychotherapy overdose: Woody Allen
    -Me too psychotherapies: EMDR, TFT
    -Adherence: Whether it's emotional cheeking or intellectual cheeking, it's called resistance. And blamed on the patient.
    -Brand name vs generic: Generic "therapy" cannot be marketed as effectively.

    Here are some of The Real Reasons Psychiatrists Want to Provide Psychotherapy