Memory and Therapy
Posted by Dr. Vollmer on December 5, 2014
“Memory is so complicated,” a psychiatrist-in-training, said to me, in talking about the Ferguson case. “Oh yes, doesn’t that explain why cookbook therapies, which only address cognition and not the emotional component to symptom formation are of limited utility?” I say, to a student who looks back at me with shock and thoughtfulness. If we agree that memory is complicated by predispositions, the need to fill in gaps, and social pressures, then can’t we also agree that symptoms such as anxiety and depression are also complete with backstories and family context which make understanding the complexity of the symptom more important than proposing a quick treatment? This is my thesis and this is why I continue to blog. The contradiction between marveling at the many aspects of memory and, at the same time, proposing that deeply held symptoms are simply treated in 12 sessions seems outrageous to me. Having said that if 12 sessions brings relief, I have no issue, but what happens when the patient does not respond to 12 sessions? Do we say they are untreatable? Do we refer them to a higher level of care, such as medication management or hospitalization? No, I say. We should understand that for some people, given the complexity of their situation, more therapy is needed, not necessarily with medication, and not necessarily requiring hospitalization or intensive outpatient programs. Complex brains require complex treatment. At the very least, we should all agree to that.