tag:blogger.com,1999:blog-7772182113499451603.post6189880415854434731..comments2024-03-27T10:50:53.692-05:00Comments on Real Psychiatry: The Balanced Rhetoric Against Neuroscience George Dawson, MD, DFAPAhttp://www.blogger.com/profile/03474899831557543486noreply@blogger.comBlogger4125tag:blogger.com,1999:blog-7772182113499451603.post-36934010431701289692016-10-25T20:57:39.605-05:002016-10-25T20:57:39.605-05:00I think that the common factors/contextual model i...I think that the common factors/contextual model is the basis of a lot of treatment is psychiatry beyond psychotherapy per se. For example, a focus on the relationship and the therapeutic alliance is what I consider to be the basis for treatment and it has to be a reference point for how seeing a psychiatrist differed from seeing a physician who is not a psychiatrist.<br /><br />When I was trained, manual driven psychotherapies for research including the authors mentioned in the post but many others were just arriving on the scene. Most psychiatrists were trained in supportive psychotherapy and psychodynamic based psychotherapy. The early supportive psychotherapy contained elements of most subsequent therapies but it was not standardized in a manual.<br /><br />I agree that specific elements of therapy should be actionable to a point, but there are some people who don't get it or for other reasons are unable to do psychotherapy. Thankfully they are very rare in the field.<br /><br />I don't think that further psychotherapy research will necessarily lead to better outcomes for the reasons I mention in the post. I don't think it is possible to treat a heterogenous population (as in any DSM diagnostic group) with a medication or psychotherapy and get better results. I think that the current psychotherapies need to be applied to groups that are selected with more precision than the DSM. <br /><br />My speculation is that will be the true value of neuroscience. A common error is that people often think that neuroscience equates to medications or physical interventions and not psychotherapy. <br /><br />For anyone interested in what the author of this post is referring to - a brief review is available at:<br /><br />https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4592639/George Dawson, MD, DFAPAhttps://www.blogger.com/profile/03474899831557543486noreply@blogger.comtag:blogger.com,1999:blog-7772182113499451603.post-20312272887811163442016-10-25T18:49:44.542-05:002016-10-25T18:49:44.542-05:00I'm curious what you think about the common fa...I'm curious what you think about the common factors/context model. That's what I think about when I read that Op-Ed, even though I think you are right that they will just do more studies trying to establish the world dominance of CBT. That aside, I have to believe that studying psychotherapy more effectively would lead to improvements in outcomes. I always think of the example of 'facilitative interpersonal skills' which, if accepted as an important ingredient of psychotherapy, could lead to modifications in approaches to training, or even in selection of candidates. Put too simply, if the therapist/candidate is 'not a very good listener' that probably is related to their effectiveness as a therapist. Seems actionable, at least superficially. Rich JChttps://www.blogger.com/profile/03257492751009320816noreply@blogger.comtag:blogger.com,1999:blog-7772182113499451603.post-7839923602109535042016-10-16T11:51:58.346-05:002016-10-16T11:51:58.346-05:00Good point.
Attachment was one of the early parad...Good point.<br /><br />Attachment was one of the early paradigms that led to some of the first biological models. At one of the places I trained several faculty were members or the primate lab and did active neuroendocrine research on attachment behaviors. I gave a seminar on psychosocial dwarfism that was observed in children in orphanages in WWII and the possible neuroendocrine basis. Since the neuroscience of attachment has become more refined. Attachment has also been a significant component of psychotherapy and psychoanalysis since Bowlby and Spitz. In medical school we had an Infant Psychiatry group that studied the works of Robert Emde - a pioneer in the field. Another good example of the relationship between the clinical work and neuroscience. George Dawson, MD, DFAPAhttps://www.blogger.com/profile/03474899831557543486noreply@blogger.comtag:blogger.com,1999:blog-7772182113499451603.post-19551837679245293992016-10-16T09:43:43.398-05:002016-10-16T09:43:43.398-05:00There's a whole lot of neuroscience that point...There's a whole lot of neuroscience that points to the importance of the social environment and attachment in shaping both brain structure and function. Most mental health clinicians of all stripes are totally in the dark about this stuff. David M. Allen M.D.https://www.blogger.com/profile/06280912088483192599noreply@blogger.com