Shirah Vollmer MD

The Musings of Dr. Vollmer

‘Too Sick For Therapy’

Posted by Dr. Vollmer on April 26, 2012

Meital, twenty-year old female, long-standing issue with drug and alcohol abuse, with long-standing history of psychotherapy, along with a history of intermittent psychosis, which could be drug-induced or it could be a primary psychotic process.  She goes out of state for an upscale rehabilitation center at which time she is forced to develop a new relationship with a psychiatrist because her new facility insists that she use their staff psychiatrist as her treating physician. Dr. Luigi, her new psychiatrist, reviews the records of her psychiatric hospitalizations, but he does not talk to her previous treating psychiatrist, me. Meital, anxious to be in a new setting, is guarded and reluctant to engage in a new relationship with Dr. Luigi. Dr. Luigi, basing his opinion on hospital records and not outpatient treatment experiences, views Meital as “psychotically withdrawn” and therefore not amenable to psychotherapy. “Maybe she is frightened and therefore she needs the time and patience of a good and attentive listener before she will express herself,” I say to the staff at her treatment center. As I say that, I am once again feeling like I hearken back to an age where listening was so valued. Instead, Dr. Luigi maintains Meital on high doses of antipsychotic medication because it is his professional opinion that she is “very ill.” I, in contradiction, think that the medication is hindering her recovery because she is overly sedated and more withdrawn on the medication, making her appear more ill than she is when she is unmedicated. Dr. Luigi and I discuss this, but no meeting of the mind happens. We agree to disagree. There are no objective tests to settle the score. I worry for Meital, but I also worry for my field, where medications not only mask underlying issues, they also cause people to misunderstand what is going on in their internal world. Maybe Meital will never have the opportunity for personal exploration. Maybe Meital will come to see herself as mentally impaired, and as a result, she will not strive to build a life for herself. The downstream of these decisions could be grave. There are people who are “too sick for therapy.” I just think Meital is not one of them. The weight of this decision point is huge. I can only hope the tides will turn.

4 Responses to “‘Too Sick For Therapy’”

  1. Shelly said

    How did you get involved in her inpatient treatment process? Did they ask for you to consult? Give your perspective? Did it alarm you to see how she was overmedicated and was being “treated”? If Meital is “too sick for therapy” then when is she “well enough for therapy?” On the other hand, if she has a long history of psychotherapy (I’ll assume it’s with you), then why does she continue with the cycle of destructive alcohol and drug abuse?

  2. Shirah said

    I have seen Meital in psychotherapy, but with this last round of drug abuse leading to psychosis, her family decided to send her out of state. The out of state psychiatrist was not interested in getting a history from me, but he did have her hospital records. Yes, if indeed she is overmedicated, which is hard for me to say, given that I have not seen her recently, then I would be very concerned about that. She does have a long history of psychotherapy, which like most treatment programs involves ups and downs. She was drug free for a substantial amount of time while she was in treatment with me, but she opted out, and soon thereafter returned to drug use. This is a common scenario, in that she may need to mature to appreciate the opportunity of psychotherapy. My concern here is that without the opportunity of psychotherapy, I do not know how she is going to become self-aware enough to stop her self-destructive behavior. Psychotherapy is not the only way in which she can learn to stop her downward spiral, but I think it should be an option presented to her. Right now, she is denied this opportunity and that leaves me with deep concern. Thanks.

  3. Danny said

    Dr Shirah,
    As far as psychoanalysis more specifically is concerned is it true that its losing its influence in the larger psychology/therapy field and in the depts of psychology at universities around the world. I was reading that there was this Report or study a few years ago back in the american psychoanalytic journal which said because psychoanalysis lacks the testable scientific methods which are used in other scientific fields, its slowly being marginalized ?

    • Shirah said

      Hi Danny,
      I am not sure that psychoanalysis is being marginalized, as much as “newer is better” mentality is trying to dominate the clinical picture. It is true that we do not have good randomized controlled studies to demonstrate the efficacy of psychoanalysis, but it is also true that we have many personal accounts of how helpful it has been to people. The problem, as I see it, is that there is a push towards “innovative” approaches, which we all know, does not necessarily mean that they are superior to the more established ways of helping people. Listening and thinking to a person’s narrative will always be a valuable experience for folks who suffer from anxieties. Thanks, as always, for your comments.

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