Psychotherapy and Medication

If you are suffering with emotional issues and are considering seeing a psychotherapist, you may also wonder about the use of medication.  Should you seek therapy alone, try medication alone, or would it be best to try both at the same time?  The answer to this question depends on a number of factors including your goal in seeking help, your feelings about the use of medication in general, and the nature of the problems you are struggling to resolve. Even your beliefs about what it means to be human are relevant.

If your goal is to shift your approach to life, understand and change destructive patterns, feel more connected to the world and integrated in yourself, and find a deeper sense of meaning, your first step might be to find a good psychotherapist  who can help you rework and resolve the underlying issues that lead to pain and suffering. While feeling better is crucial, and feeling bad may be what brings you to therapy, people are often also motivated by a desire to grow, to become more open, and to feel they are fulfilling their potential. Reducing your pain is critical, but you may want more from your life. In some cases, medication may help the therapy process, but medication alone will not address the basic issues.

If your primary desire is to make your pain and suffering go away as fast as possible, and you have little interest in working on deeper issues, your first step might be to visit a psychopharmacologist. A psychopharmacologist is a psychiatrist who specializes in the use of drugs to treat emotional states and psychiatric disorders. Depending on a host of factors, it is sometimes possible to reduce anxiety or depression and improve other difficult emotional reactions through the use of medication alone. Still, even the best medications are not a silver bullet. For example, research reported in The Journal of the American Medical Association in 2010 found that the effect of antidepressant medication on mild to moderate depression may be minimal when compared to a placebo, although when used to treat very severe depression, the effects of antidepressants over placebo are substantial.  Beyond the questions of efficacy, virtually all psychoactive medications have side effects, some of which may be severe and debilitating.

Medication may be useful in helping people feel well enough to begin the process of addressing deeper issues related to overwhelming inner conflict, the effects of serious trauma, and profound depression. For instance, people who feel so overwhelmed by anxiety they can’t even begin to focus on the reasons for their suffering, or so depressed they feel paralyzed and unable to begin to take any action, may not be able to start working productively in psychotherapy until these states begin to shift. Although medications may be helpful here, they are clearly not the essence of psychotherapy. To really address the confusion and pain in life, one needs to clarify and change what leads them to act and to feel the way they do. Some of these factors will be historical, and some will be related to current life circumstances; some may be conscious, and some may be unconscious.  Medication may help reduce the overwhelming symptoms that get in the way of doing the work of psychotherapy, but it does not substitute for going through the sometimes difficult struggle of becoming more at ease with who you are, and more of who you want to be.

It is also important to note that a person’s decision about the use of medication can reflect their personal perspectives on spirituality, philosophy, science, and what they believe to be meaningful in life. Do you think of yourself as a bundle of chemical receptors and physiological processes — that people are basically highly complicated machines? Or do you see your feelings and experience as basic to who you are as a whole person, transcending the physical state of your body and its biological processes? Perhaps you see the entire system interacting – chemistry and mind, biology and psychology. The idea that depression is a simple effect of a biochemical imbalance has become very popular in recent years, yet this point of view is far too simplistic and is frequently not supported by the evidence.

In seeking help for emotional problems, it is important to think about just what kind of help you really want, and what you hope to achieve. Think about your world view and what you find meaningful in life. Recognize that inner change is not equivalent to the immediate reduction of emotional pain. If your instinctive approach is for a quick fix, it may be worth thinking about the bigger picture. If you have a reflexive reaction against the use of medication, you may want to consider the possibility that medication may be an aid, though it’s not the solution. Whatever your feelings are, you should expect them to be listened to carefully and respected by whomever you ask for help. There are some situations in which the use of medication is advisable, such as when a person is in imminent danger of doing serious harm to themselves or someone else. Still, those offering help have the responsibility to listen closely to your concerns and to try their best to understand you and take your concerns into account.

Summary
Article Name
Psychotherapy and Medication
Description
The potential role of medication in therapy, including the question of when and why you might -- or might not -- consider it.
Author

About Marc Handelman, PhD

I am a licensed clinical psychologist practicing in New York City. My office is located on the Upper West Side of Manhattan, near Columbia University. I work with adults from college age and up who want help addressing problems ranging from depression, anxiety, and relationship issues to addiction, co-dependency, and the effects of early trauma.

I believe psychotherapy should provide a sense of comfort and support as the starting point for addressing emotional problems. I have more than 30 years’ experience as a psychotherapist, and have been affiliated with The Hazelden Foundation since 1997. Please see my professional website for more information: http://www.psychotherapy-nyc.com

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