Posted by violette on July 25, 2010, at 12:26:02
In reply to Re: toxic crap, posted by violette on July 25, 2010, at 11:51:59
Anyway, this article considers some things I'm trying to say here...I think the exclusion of psychology by psychiatrists is detrimental to medication outcomes for many people, and that psychodynamic formulations that include looking at the psychological side as opposed to only biological means, can improve treatment outcomes.
http://jppr.psychiatryonline.org/cgi/content/full/7/1/35
For my situation, I was able to repress and adapt to my childhood trauma for a considerable portion of my adult years. When my ego could no longer contain the emotional trauma-I got depression and anxiety symptomology, which basically matched the description of PTSD with a delayed onset, which was triggered by events-one of which I never would have connected to my illness if I had continued meds instead of reading about psychology. This was because, in part, psychiatrists only prescribed me medications, which delayed my recovery.
And this leaves me wondering how traumatic events during childhood or teen years, even seemingly non-traumatic events such as the intrusive parent, effect others here whose treatment plans only include medications?
Even though this article is geared towards PTSD, PTSD from childhood issues was not defined until after the Vietnam War--when it was recognized that from orphanages had higher rates PTSD than vets, with the same symptomology as those Vietnam Vets, while having lower recovery rates (see Wiki on that one). And 'PTSD' can manifest as a continum...like any symptomology.
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"Currently, the symptom-oriented organization of the Diagnostic and Statistical Manual13 and the increasing availability of medications and behavioral approaches to treat symptoms directly may deflect clinicians from exploring the meaning of recent precipitating events and the complex relationship of such events to their patients' symptoms. Pharmacologic treatments, while often very helpful, are limited by side effects, incomplete results, and lack of acceptance by those patients who prefer to solve problems more definitively in psychotherapy.14 Cognitive-behavioral therapies, although reported to be efficacious in Vietnam veterans and rape victims,15 consist of discrete treatments for specific symptoms and do not easily lend themselves to application in more complex clinical situations. In addition, there has been little systematic investigation of what works best in whom.16 As with pharmacotherapy,some patients refuse to participate, and others may find such treatments ineffective or insufficient. At the other end of the spectrum, inexperienced clinicians armed with the PTSD diagnosis may overzealously explore traumas psychodynamically without adequate attention to the vulnerable state of the patient's ego functioning,17 thus overwhelming the patient's capacity to cope."
"Initial psychodynamic assessment usually takes place during approximately three 1-hour sessions. While exploring the patient's current problems, past treatment, early development, and social relationships, the interviewer also assesses mental status both indirectly and, when necessary, by asking direct questions. Although keeping in mind areas to cover, the interviewer is not limited in advance to prestructured questions and leaves time for problems and reactions to emerge spontaneously. In addition to focusing on specific symptoms or behaviors such as those listed in DSM-IV, the interviewer attends to patterns of symptom occurrence and recurrence. Using this information, as well as concurrent observations of the patient's behavior and affects, the interviewer evaluates the patient's past and current ego functioning. When the symptom picture suggests acute regression from a relatively high level of functioning but the relationship of symptoms to recent events remains obscure, an extended evaluation, combined with a trial of psychodynamic therapy, may be necessary for more definitive diagnosis and treatment."
"Despite difficulties studying psychodynamic treatments, a controlled study demonstrated that psychodynamic psychotherapy was as effective as hypnotherapy and trauma desensitization for PTSD when treated patients were compared with wait-listed control subjects.18 Patients treated with psychodynamic psychotherapy showed symptomatic improvement somewhat later than other treated patients, but they showed unexpected, and comparably greater, beneficial changes in personality traits."
"Recent reports document that posttraumatic reactions may be long lasting if not treated effectively. Rose,19 surveying the literature, found that brief supportive psychotherapy for adult survivors of sexual assault had frequently been inadequate to deal with persistent symptoms, even in patients with no preexisting psychopathology. Nader et al.20 described the considerable degree to which children remained symptomatic 14 months following an acute disaster. Terr21 prospectively studied children exposed to a day-long schoolbus kidnapping that involved no physical harm. The children showed symptoms of posttraumatic stress 4 years later, despite brief psychotherapy. Kessler et al.22 found that although treated patients fared better than others initially, one-third of all people with an index episode of PTSD failed to recover even after many years. These data suggest a pressing need for further research into the efficacy and methodology of psychodynamic psychotherapy with traumatized patients.
In this article I will focus on patients who come to treatment with acute symptoms following specific recent experiences and who have functioned at a relatively high level prior to the onset of these symptoms. Although the ego psychological approach to treating patients who complain of severe, chronic symptoms is beyond the scope of this article, the same approach can be clinically useful in understanding such patients.
poster:violette
thread:955512
URL: http://www.dr-bob.org/babble/20100720/msgs/955842.html