Psychotherapy alone may be the preferred treatment for many people with depression, anxiety, relationship problems, and adjustment difficulties (loss, medical illness, divorce, trauma, etc). For people who require medication to reduce symptoms the addition of psychotherapy is often associated with greater improvement and reduced likelihood of relapse of the illness. Individual and family therapy may also assist people with psychotic illness by providing support and guidance as well as reducing stress and conflict that may cause a worsening of symptoms.
Psychotherapy comes in various sizes and flavors. It is important to have the type of therapy that is effective for the type of difficulty you are facing. It is also very important to work with a therapist you trust and who has the needed skills to assess with you your situation and provide appropriate forms of therapy. There are generally two goals of therapies. To assist the patient to be less comfortable with and to question ineffective or self-destructive patterns of thought and behavior and to assist the patient to become more comfortable and more effective in situations that, at the start of therapy, make them uncomfortable.
What are some of the different types of psychotherapy?
Psychodynamic Psychotherapy is an outgrowth of psychoanalysis. It incorrectly has the reputation of being a fishing expedition looking at the past. In fact this type of therapy is intensely focused on the here and now. The patient has current real world experiences and tells the therapist about what goes well and what difficulties have been encountered. Not only does the therapist pay attention to what the patient is saying but also to how it is being said and how (s)he is communicating and interacting with the therapist. The therapist also pays close attention to the emotional tone in the session. The patient's job is to say what comes to mind and the therapist's job is to look at patterns of how the patient relates not only to his or her world of work, family, and self but also to the therapist. Inevitably we all have patterns that work and some that don't work as well. The effective work in this type of therapy comes when those counterproductive patterns are present between patient and therapist. The therapist assists the patient, in the here and now of therapy, to recognize and understand those patterns of feelings, thoughts and behavior and to find more effective ways to handle conflict, discomfort, and distress.
For this reason the therapist who approaches the work with a psychodynamic frame of reference will tell the patient at the start of therapy that they, the patient, will likely, at some point, experience some of their feelings of distress in the therapeutic relationship. This provides a here and now opportunity to learn together exactly what it is that happens for the patient. The therapist's job is to tell the patient what he has observed and assist the patient to question old assumptions and automatic responses in order to come up with new and more effective ways of understanding and relating to himself and others. This "living the problem with the therapist" and finding new solutions is a powerful and transforming tool. It is a therapy aimed at personal emotional growth and personality change.
Cognitive Therapy is in part an outgrowth of psychoanalytic psychotherapy and also what is known as rational therapy. It is aimed at symptom reduction not personal growth or personality change. The focus of this work is for the therapist to pay close attention to what the patient is saying and to identify, with the patient, faulty thoughts (cognitions), assumptions and conclusions that cause the patient problems, distress and unhappiness. For example reducing anxiety attacks by examining a patient's automatic assumptions that they are going to have a heart attack and die whenever they become short of breath. Forms of cognitive therapy are used as specific treatments for symptoms of depression, anxiety disorders, eating disorders. These techniques are also used to reduce symptoms in people suffering with personality disorders, but are not intended to alter the basic personality.
Behavioral Therapy focuses on maladaptive behaviors and traditionally provides a structure in which new desired behaviors are identified and the patient is rewarded on a regular basis for using the desired behavior. For example a child is given points towards a reward for each 15 minute interval he keeps his hands to himself instead of pushing his brother. Another specific behavior therapy is known as Exposure and Response Prevention the treatment of choice for Obsessive Compulsive Disorder. For example someone with hand washing compulsions may in the presence of his therapist touch a doorknob, then sit with the anxiety about germs and not wash until the anxiety goes away (while using other techniques to manage the anxiety). Many behavioral therapies are combined with techniques from Cognitive Therapy resulting in what is known as Cognitive Behavioral Psychotherapy (CBT). These therapies are particularly useful for anxiety disorders- including Obsessive Compulsive Disorder, eating disorders, addictive disorders. Sites that have more information about CBT: www.cognitive-behavior-therapy.org and www.nacbt.org
Supportive Psychotherapy uses techniques including active listening, affirmation of thoughts and feelings, education, problem solving, advise, role playing, setting realistic goals, and strategy development, a to assist patients to tackle practical problems that they face. This is the most predominant form of psychotherapy practiced. It is not intended for personality change or emotional or personal growth but to enhance and support the person's adaptation to their life circumstances. This link takes you to a web site that nicely describes components of supportive techniques for patients with chronic pain: www.bayareapainmedical.com/suppsych.html
Other therapies you may have heard of include Couples or Marital Therapy, Family Therapy, Group Therapy. These names describe the participants in the therapy. The above described therapy types, and others, may be used as the framework for therapy in these situations.
Why see a Psychiatrist for Psychotherapy?
Psychiatrists who provide psychotherapy have far more mental health and psychotherapy training than most other types of psychothrapists. Furthermore, psychiatrists are the only mental health practitioners qualified to provide psychotherapy and medication treatment. Most psychiatrists in Charlotte, NC limit their practice to psychopharmacology (treatment with medication). It may well be worth your while to consult with a psychiatrist who is adept at providing psychotherapy as well as medication management.
Even if you are not looking to be on medication there are good reasons to consider seeing a psychiatrist for psychotherapy. In general a psychiatrist who is well trained in psychotherapy has a broader and deeper exposure to the types of mental health problems people experience than do other mental health professionals. Also, at times what seems to be a mental health problem turns out to be a medical problem with mental health symptoms. A psychiatrist, because of his or her medical training, is more likely to recognize it than a non-medical therapist. For people who have medical problems, therapy with a psychiatrist may be just what you are looking for: Someone with a good understanding not only of the medical problem but also of the real life problems and emotional challenges encountered with illness.
Often people enter therapy with a social worker, psychologist or counselor only to be referred to a physician for medication (a practice known as "Split Treatment"). This is a good recipe to end up on medication that might not be needed. If the doctor has only a hammer (the psychiatrist who only provides medication) you, the patient, are more likely to have a hammer used than if the doctor is skilled in the use of several tools and can choose which would be best for your situation. Furthermore, in this situation the therapist doesn't know much about medication and the doctor, who will spend and hour- and likely less- with you will know even less about you. With a psychiatrist providing psychotherapy you don't have to get to know two different practitioners and wonder how well they are communicating. (In fact, you would be surprised how poor communication can often be in split treatments). Therapy with a psychiatrist allows therapy and assessment for medication to unfold together. This ongoing close work with a psychiatrist can avoid unnecessary use of medication.
At the other end of the spectrum, a therapist may not recognize the need for medication, or may be uncertain and delay referral resulting in a prolonged and therefore more expensive treatment. With a psychiatrist as therapist any uncertainties about medication can be addressed without delays or having to wait to get yet another appointment.
When medication is needed, studies have shown that psychotherapy and medication provided by one practitioner (a psychiatrist) results in improvement over a fewer number of visits than when a psychiatrist (or other physician) provides medication and the patient sees someone else for psychotherapy (Split Treatment). In split treatment the reports of another competent practitioner to a psychiatrist do not fully duplicate what is learned directly from interactions between patient and psychiatrist during psychotherapy visits.
A psychiatrist's fees generally, but not always, are higher than those of non-medical mental health providers. This reflects the much longer and extensive training psychiatrists receive (eight years for an adult psychiatrist and ten years for a child and adolescent psychiatrist) in assessing and treating medical, psychiatric and psychological problems. Some studies have shown that the overall expense of seeing a psychiatrist who provides psychotherapy may in fact be less due to the fewer total number of visits needed with "one stop treatment" versus split treatment.
Why should I consider seeing Warren Steinmuller, M.D. for psychotherapy?
Dr. Steinmuller is a Child, Adolescent, and Adult Psychiatrist with over 25 years experience in providing individual and family psychotherapies. He is an expert in assessing and treating a wide range of psychiatric, emotional, and psychological problems (and has been providing care in Charlotte, NC since 1991). He will provide you a comprehensive and thorough consultation, in a warm and compassionate manner, to understand your situation, assess your mental health needs and to discuss with you your treatment options.
Many people seeking help require only psychotherapy to feel better and do not need medication. This is true of many of the people who see Dr. Steinmuller. However, because Dr. Steinmuller is skilled in psychotherapy (psychodynamic, cognitive, behavioral, family, parental) and in the use of medication he is also able to provide "one-stop treatment" for people who's treatment will be more effective with the combination of psychotherapy and medication. His ability to provide both aspects of treatment avoids extra or wasted interventions that may result from a split treatment. The time, effort, and expense of coordinating treatment between different practitioners can be reduced or eliminated. There is no extra fee for medication management with Dr. Stienmuller as this care is included with the psychotherapy visits. In addition,if the need for medication is unclear or uncertain at the start of treatment, ongoing assessment can occur during psychotherapy visits without the need for you to see yet another doctor.
Warren J. Steinmuller, M.D. Child, Adolescent, and Adult Psychiatry and Psychotherapy 225 E. Kingston Avenue Charlotte, North Carolina 28203 (704) 376-7654
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