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There is one thing that is virtually guaranteed….if you go to a mental health center, you will probably see a psychiatrist for medication.  In my private practice probably 10-15% of my patients take medication.  When I worked at a mental health center, it was closer to 90-95%.  What accounts for this vast difference?

1.  In a mental health center, the assumption is that patients will be referred for medication.  It is the basic assumption.  There is also a financial insentive.  Mental health centers get paid more for the services of psychiatrists than therapists or psychologists.  Funding is ALWAYS a very important issue in mental health centers.

2.  In private practice, most of the responsibility falls on me (instead of a system).  I explain the options to my patients, that they may be interested to try medication, but as long as the problems do not represent a serious risk (loss of job, harm to self, ect…), medications may not be warranted.  Although it is a very individual decision.  So far, every patient I have seen that comes to me first without being on medication, does not start on medication.  The majority of those who are intially on medication are able to get off of the medication eventually.

3.  Expectations…  All shrinks are human beings.  They have different expectations of their patients.  They have different expectations about what is possible with psychotherapy.  They have different levels of knowledge.  They have different levels of comfort.  They have different views of human nature.  These factors are critically important in how psychotherapy unfolds with a patient.

4.  What seems to be much more important than diagnosis is a willingness on the part of the patient to keep coming in to treatment, to think about what is discussed in session between sessions, and to have a genuine motivation to make changes.  Now, certain diagnoses sometimes make these things less likely (severe schizophrenia, severe bipolar disorder, or severe personality disorders for example).  However, if these things are present (the positive factors), the diagnosis is much less significant.

5.  Psychiatrists often “diagnose for the medication.”  The FDA approves drugs for specific diagnoses.  Nobody likes to be sued.  So, psychiatrists often bend or distort the diagnosis in order to justify the medication they want to try.  See my previous post, Diagnosing for the Medication.

So, while the desired medication is more important than symptoms at times for psychiatrists, for some therapists and psychologists, what is more important is a willingness to seriously consider what is talked about in-session, a willingness to follow through with recommendations, and a willingness to believe that psychotherapy may be helpful.  To a great extent, the actual symptoms a person has are less important than these factors.

Now, I’ve seen some folks with the most rigid belief systems (such as blantant paranoia and fantasies of revenge), that are only addressable on a spritual basis.  Absolutely nothing else works at all–believe me, I’ve tried.  But, when they consider their thoughts in the context of their belief in God, they are willing to acknowledge the distortion and errors in their thinking.  There are times when a person’s difficulties can be addressed in nothing other than a spiritual realm.