1. When I decided to study psychology, I was primarily motivated by wanting to improve the manner in which therapy sessions were conducted. I wanted greater intensity, lesser patients and more commitment to the few I’d take. The way things are done here, due mostly to financial reasons and a discrepancy between demand and supply, is that a person sees their psychologist/therapist/psychiatrist once a month. In milder or chronic cases that are unlikely to worsen, even less frequently, once in three months. Waiting times can be a month as well if you want national health care service. This is not conductive to improvement. There are so many people out there who haven’t found seeing a therapist/psychiatrist helpful. People who have felt very alone with their problem. You’d need to be incredibly strong-willed, motivated and prepared to do 90% of the work yourself to obtain a result. A lot of people are not strong-willed, motivated or high in self-efficiacy. They look to the doctor or therapist to fix them, but the doctor or therapist isn’t there when needed.
I do think medicine should be more about cooperation between the doctor and the patient, rather than the patient meekly accepting whatever the doctor prescribes, and placing all responsibility for treatment success on the doctor. In a lot of conditions, there is much the patient can and should do to improve and speed up healing. Psychology and psychiatry are very different from traditional medicine, however. They treat what can be invisible and hard to measure, so the usual treatment frames do not work. It is my belief that the role of the doctor/therapist is too peripheral for some of the conditions one is dealing with. I am not referring to people who have time to spare to untangle their unhealthy life patterns, like why they are so irritatingly competitive or incapable of commitment. Such people can afford seeing their therapist once in three months. They are sufficiently healthy and capable not to require intensive care, but people with depression, anxiety, post-traumatic stress are very far from it. In such cases, the cooperation should be intenser and the doctor/therapist should be more available to the patient.
Distance works when dealing with treating the majority of bodily diseases. The medicines and treatment guidelines are fairly straightforward. Take this pill twice a day, avoid eating X and Y, get plenty of rest; if the condition worsens, call back. Come for a check-up in a week or a month. There is clarity and the person, unless bizarre side-effects or symptoms occur, has no need for a doctor until the check-up time. This is not so in psychology or psychiatry. The conditions a person experiences can often be surprising, bizarre, unbearable, the pills may not work, the side-effects can be more frightening than the condition. Point is, people are scared and would need constant attention, and they shouldn’t feel they are imposing when they call their therapist out of hours. Left to their own devices, the majority does not improve or it takes years. Alternatively, the condition heals on its own, which once again makes the psychiatrist/psychologist more or less useless.
Right now, the primarily role of the psychiatrist/psychologist is to diagnose and tell the person what is wrong with them. This is important too, but in the treatment phase, the person is very much on their own. I think mental health problems are things one shouldn’t be alone with, until obvious improvement has occurred. One CAN be alone with them and self-treat, or get better naturally because time is a great healer, but then we cannot speak of the psychologist (who cannot even prescribe pills) as being particularly useful or necessary.
2. The second reason, beyond the fact that a psychologist cannot give their patients as much time and attention as their conditions would require, is that mental health issues require a person who “gets you”, who would actually be capable of going on the level of the patient, seeing where they are coming from and why they are the way they are, and trying to help them from this position. It is not possible for any psychologist to understand all people and all their problems equally well, or have the motivation to do that. A professional would of course know the procedure for certain conditions and the typical symptoms of it, but this is not real understanding and the patient would feel it and be disappointed. Patients do get disappointed when they undress their soul, but get thinly veiled incomprehension or standard responses in return.
This is not the psychologist’s fault that the patients are very demanding in this particular way, but that they often are is also a fact. I’ve witnessed a number of people say that they found more help talking to people with the same problems, usually on the internet, than when seeing their therapist. I’ve also heard the opinion that one’s best friends are one’s best and real therapists.
If one leaves the hierarchical doctor-patient relationship aside for a second, it is not that common in life to find persons you click with either, but for some reason patients with mental health problems expect their therapist to be that person – someone who ‘gets them’ and gives advice that will transform their life. This is an illusion, but the patients are not to blame for their illusion. If a sick person goes to a doctor, it is natural they expect to return feeling better or having the security of pills they can take to improve. It can be very frustrating for mental health patients not to experience it.
There is a solution for this problem too, which others have come up with before me. There are trained support persons who have experience with the same condition or situation the patient undergoes and who’d hopefully provide what a psychiatrist or psychologist may not be able to. There are never guarantees, but this would alleviate the availability of support problem I wrote about in point 1 and the chances of clicking with your support person are higher too. Sadly, the bills of such a comprehensive service must be huge and most people are not aware of this option nor its possible benefits.
Unrelated, but on a similar theme:
I think that with the decline of religion in the West, a lot of us have not only lost the purpose in living, but also lost the opportunity of having someone to unburden oneself to, such as the priest or the function the confession had, or perhaps even god.
Who does one talk to if they have no close friends they can trust completely? Especially if a person has done something bad or morally dubious. If you tell that to a friend, you risk losing a friend.
I’d like to be a non-religious priest to non-religious (or religious, I don’t discriminate if they prefer me) people. Like Holden with his catching children business, I’d like this to be my job. The funny thing is that I don’t even want to be as non-judgemental, but I somehow cannot help it on an individual level. I may disapprove of a thing on the level of an idea, but when I hear a person out, I am more likely to sympathise. Sometimes I’m ashamed of myself for the people I can be made to emphatise with. But what can you do. Overdeveloped empathy, underdeveloped sympathy.