Gerald P. Perman, MD, PA
2424 Pennsylvania Avenue, NW
Washington, DC 20037
Psychiatric illnesses have a variety of causes. These are usually due to an interplay between “nature” and “nurture.” Contributions from “nature” include those attributes with which we are born and include such things as our temperament (starting with whether we were difficult or easy babies) and our family histories of psychiatric illness such as having parents, sisters or brothers with bipolar disorder or alcoholism. Attributes due to “nurture” result from the family and social environments in which we grew up. Healthy family influences can help make up for less-than-perfect genes. Psychotherapy primarily addresses those aspects of psychiatric illness due to “nurture.”
Although patients may have a psychiatric disorder such as panic disorder, major depressive disorder, obsessive compulsive disorder, PTSD or bipolar disorder, people seek out psychiatric help because they are feeling anxious, depressed, or both. Usually the first order of business of the mental health professional is to help the person feel better. The first step in treatment today is often medication prescribed by a psychiatrist or, more commonly, a general physician, to help ameliorate the anxiety, depression, insomnia or other psychiatric symptoms. These medications are often helpful but may only treat part of the problem or make things better temporarily. It is then that a person seeks out or is referred for psychotherapy.
There are many brands of psychotherapy. The one that is still the most widely used by psychiatrists today is called psychodynamic psychotherapy and was developed out of psychoanalysis. This approach believes that the psychological causes of anxiety and depression originate from unconscious conflicts. For example, a person who cannot get over the loss of a romantic relationship or the death of a loved one may be harboring unconscious hostility or resentment toward the other individual for leaving (or even dying). But because the depressed or anxious person is kind and loving, he or she is unable to acknowledge such negative feelings. We would say that the unacceptable, angry feelings remain unconscious. By talking with a mental health professional over time these disavowed feelings can slowly be brought to the surface and acknowledged. As this happens the anxiety will subside and the depression will lift. This method is applicable to a wide range, although not all types, of psychiatric problems that cause people to seek psychiatric help.
Psychodynamic psychotherapy often begins to show its effectiveness within the first few visits. At the same time the reasons that led the person to seek psychiatric help in the first place usually have been going on for months or longer so that a certain amount of persistence and tenacity on the part of the patient are often required. The results can be extremely gratifying with the restoration of the person's sense of well-being, mood, view of the future, and improved relationships with family members, friends and co-workers. An increasing number of studies have shown this form of psychotherapy to be “evidenced-based” and outcomes compare favorably to treatments in other areas of medicine.