Psychiatry Consultations and Counselling Services  in  Goa, India 

Psychotherapy

by  Ashutosh Prabhu Dessai, MD

There are two main types of treatment for majority of psychological conditions, namely medications (or psychopharmacological treatment) and psychotherapy. A combination of both, generally gives better results than either of them alone. 

In India as well as in other places too, people refer to psychotherapy by the popular lay term counselling though they are not exactly synonymous.

Misconceptions about psychiatric treatment

1. Only by taking medications one will feel better rapidly.

Medications do bring about improvement in many psychological disorders however it is not always that only medications can bring about improvement when the cause of the problems is systemic or external or due to personality traits  such as being anxious or insecure etc. which need to be addressed especially through psychotherapy.

This latter mode of treatment is also equally as efficacious as medications if not more, but many people in this country do not realise this  due to the lack of awareness about therapy as well as strong conditioning and belief in the medical model of treatment as in physical medicine.

Another limitation of treatment with medications alone is that  the client does not learn how to modify or improve his thinking, behaviour or personality traits or reactions to the environment and precisely, this is the great advantage of doing therapy.

Often the requirement of number of medications itself or the doses  comes down as therapy proceeds due to reduction of symptoms and anxiety in the subconscious mind, as it begins to cope better.


In a  case where the client,  a student in a professional college was severely unwell and nonfunctional for 8 years while on 10 simultaneous medications most being taken twice or thrice daily. He was unable to attend college or study due to symptoms. He would wake up at 3 or 4 am and wander in the village , knock on people's doors and get beaten up. He also would would eat gutkha several times a day. On account of all this he needed to be taken 2-3 times a month to the doctor by taxi for medication adjustments incurring significant costs on travel, medications, etc. 

As the client slowly recovered with therapy, becoming increasingly functional he began studying for over 8 hours a day to try to complete his course but due to the long non attendance he had  lost University permission to continue his course.

As he became increasingly functional, it was possible to gradually discontinue 7 out of 10 medications one by one. Thereafter on full recovery he began working overseas independently where he worked free of relapse for several years despite night duties and living alone. A few years later he got married and is settled and remains well .

This of course is a time consuming process taking several months, needing patience courage and perseverence on the part of patient and family to continue with therapy despite ups and downs which are inevitable in any therapy.

This client has provided a video message which can be viewed in person by any client doing therapy.  

Therefore excessive reliance on medications for every condition is ill founded.

2. How soon will the medications, one is taking, work? It is expected that effects will be seen in a few days and one will feel better.

The nature of the brain is such that for most medications to show optimal effect, 6-8 weeks or even more are required with current state of development of modern psychopharmacology. Some effect though, may be seen after 1-2 weeks. Similarly changes in dosage etc also take long to show effect.

3. One needs to  finish the course of tablets prescribed before coming for follow up after initial consultation.

Psychiatric medication is not a course to be completed like antibiotics, of which many people have experience with their family doctors. For majority of conditions medium or long term treatment is needed and generally only very low doses are given initially to see how medications are tolerated. The optimal doses required to produce clinical response have to be built up gradually after being sure the medicines are being tolerated without important side effects so the patient is not discouraged from taking treatment itself if not the medication and the effects and side effects need to be carefully monitored.

Details of side effects can be seen on http://www.medsafe.govt.nz/profs/datasheet/datasheet.htm

So continuing the dose given at initial visit for long without adjustment as per clinical response, may not produce optimal effect and may lead to feelings of demoralisation about treatment and consequent failure of treament.

For this upward or downward titration of doses and monitoring of side effects, close follow up is required which can be initially weekly or fortnightly and later monthly or as advised depending on the condition being treated.

Misconceptions about psychotherapy or counselling

Many people and sometimes parents too consider counselling to be - that some one will give advice or a long talk to them or to their child and tell them what they should do in an authoritative manner, as is customary in the local culture, and as result of which his problem will improve.

This is actually not how the process is in professional psychotherapy. 

People also erroneously believe that only if there is a lot of discussion or if the discussion is pointed only towards their symptoms (troubling complaints)  that therapy has been done but not if general topics are talked about, which the client enjoys talking about or about his hobbies or positive aspects of his life which he otherwise would have liked to talk  about. Many clients feel this does not amount to therapy  and that mere listening is not likely to be beneficial or that it constitutes therapy.

In reality  compassionate listening with giving of understanding into ones thinking and personality and even time spent with minimal discussion but in a non judgemental and enabling environment wherein one feels valued, respected, cared for and perceives he is treated honestly and fairly is highly beneficial and are indicators of a good therapy irrespective of the topic discussed.

Frequently asked Questions

What is the difference between Counselling and Psychotherapy?

Counselling is quite popular in educational, industrial, social work, health and military fields with the aims of guiding and helping people to make rational decisions, make plans for constructive   pursuits, find best community resources to fulfil present and future needs and also to overcome reluctance and fear of action.

Counselling is utilised for guidance  in education, employment counselling for selection placement and morale building in industry, rehabilitation counselling to help people with disability to become productive etc. Family agencies offer counselling to assist in interpersonal difficulties, personal adjustment, environmental problems , economic problems , housing, health problems and disabilities such as intellectual disability etc. The methods employed are, giving advice, reassuarance and encouragement, guidance in clients role in family and society and clarification about feelings, attitudes and deviations.

Psychotherapy on the other hand,  involves being able to diagnose symptoms of emotional or mental illness by virtue of advanced training in psychology and/or psychiatry as well as the process of psychotherapy, understanding of dynamics, and subconscious processes that are likely to arise during the therapy process, knowledge of cultural factors which influence value systems and thus symptomatology and finally the understanding of one's own unconscious processes which are likely to arise during therapy.

Particularly important is the diagnostic skill to differentiate conditions such as depression from various other psychological disorders and decide upon an appropriate line of treatment.

A counsellors role generally is limited to providing support , guidance, encouragement and information and does not involve making a diagnostic assessment, or dealing with unconscious processes or personality factors which cause impediments  etc.

A psychotherapist is a professional trained in psychotherapy and is usually a medical professional such as psychiatrist or psychologist with appropriate postgraduate training.

What is psychotherapy?

Psychotherapy is a modality of treatment for emotional and psychological problems and can be taken in lieu of or along with medications as per the need or indication of the condition which is diagnosed.

In individual therapy, the client interacts with the therapist weekly (or twice weekly) , one on one, on a fixed day and preferably fixed time so that importance of therapy can get impressed on his subconscious mind and thus facilitate its acceptance by his mind.  

The client expresses or is encouraged or permitted  to express his/her emotions and feelings about the issue  with which he is affected as well as other issues which may be affecting him , in a neutral and non judgemental and emotionally supportive environment.  

The therapist reflects his thoughts and emotions back and the client views himself, in such a transaction, like in a mirror . This produces an understanding about himself and his reactions, emotions etc. This besides being treated with an attitude of understanding and  care  produces healing in his subconscious mind leading to amelioration or resolution of the problem.

In family therapy the entire family interacts with the therapist as above when the problem is in relation to the family system as a whole.

Does the discussion remain confidential?

The entire discussion is held strictly confidentially.

What is the duration of therapy required for cure?

The recovery depends on the client's subconscious mind if it is going to accept the understanding which arises through this interaction. If it does, then improvement or recovery occurs.  If it does not, then progress is slow or does not occur.

One may decide to commit to a fixed duration of therapy and try it, to see how one responds or refer to online literature from sites such as http://emedicine.medscape.com/, about the condition/s one is diagnosed with and see what the guidelines mention about usefulness of therapy.

Can functioning improve quickly with psychotherapy since one cannot spend so much time and effort in psychotherapy?

Some clients harbour magical expectations that their symptoms of difficulty in functioning, to improve dramatically with psychotherapy so that they are able to enjoy life, without they being able to cope with or correct the underlying cause of the problems, even  when it is an external stress  ( not an inherent brain disorder ).  Such magical practice of psychiatry is virtually impossible with the current state of advancements in psychiatry.

It would be more advisable if the client focusses on improving any faulty or negative thinking, behaviour, attitude, etc after discussion with the therapist instead of expecting sudden improvement in performance and allows sufficient time for the brain to rest and heal. If medications are also being taken then they too need to be given adequate time, of 6-12 weeks after their doses are built up to optimal levels, for beneficial effects to be seen.

Is it possible to  know others experience with psychotherapy?

It is possible to speak to other clients anonymously over telephone, if they agree to do so, via the therapist to know their experience with therapy which they are pursuing, albeit for different indications.





Psychotherapy

From Wikipedia, the free encyclopedia

Psychotherapy is the use of  psychological  methods, particularly when based on regular  personal interaction, to help a person change and overcome problems in desired ways.

Psychotherapy aims to improve an individual's well-being and mental health, to resolve or mitigate troublesome behaviors, beliefs, compulsions, thoughts, or emotions, and to improve relationships and social skills. Certain psychotherapies are considered evidence-based for treating some diagnosed mental disorders.

There are over a thousand different psychotherapies, some being minor variations, while others are based on very different conceptions of psychology, ethics (how to live) or techniques. Most involve one-to-one sessions, between client and therapist, but some are conducted with groups, including families.

Psychotherapists may be mental health professionals such as psychiatrists or psychologists, or come from a variety of other backgrounds, and depending on the jurisdiction may be legally regulated, voluntarily regulated or unregulated (and the term itself may be protected or not).

https://en.wikipedia.org/wiki/Psychotherapy