Shirah Vollmer MD

The Musings of Dr. Vollmer

New Academic Year

Posted by Dr. Vollmer on July 10, 2015

 

My old students have moved on and my new students have moved in, so to speak. “I saw a psychiatrist, but I did not talk to him,” a new patient says to me, and I  repeat to my students, emphasizing that we must turn this tide around. The twenty-minute appointment, even if you did that in practice, does not allow time for you to learn to speak to patients, I say, reminding them, that pre-Prozac, what we offered patients, that no other physician offered, was time. I teach in a program in which I fight for relevance. “There is no evidence,” the student reminds me, that psychodynamic psychotherapy makes an impact. “That is true, but how do I understand the look in a patient’s eye when I say something meaningful to him?” I respond. Yes, that is not scientific, but it is compelling that both the patient’s words and my words create meaningful change in the patient’s mental health. Together, the patient and I, can create new connections, new wiring, in which the patient learns confidence and impulse control. Confidence, meaning another word for self-love, I continue. Sometimes I wonder if I am teaching, or making a case for psychoanalytic training, or both, perhaps. I challenge my students to challenge their other professors, maybe not directly, but in their minds. “Head-meds only go so far,” I say, again pleading for a curiosity about motivation and self-sabotage. How did this happen? I wonder to myself. Who invented this 20 minute “head-med” appointment? Who thought to tell patients, if they try to extend beyond 20 minutes, that they should talk to their therapist? We, psychiatrists, are now telling patients we do NOT want to listen? This tide must turn!!!!

4 Responses to “New Academic Year”

  1. Ashana M said

    There is substantial evidence that psychotherapy is effective at least or depression (Lipsey and Wilson, 1993; Robinson, Berman, and Neimeyer, 1990; Lambert and Ogles, 2004); . There is little evidence that psychodynamic therapy is more effective than other psychotherapies, but it is not less effective, and it is more effective than medication.

  2. essemdee said

    There IS evidence that psychodynamic psychotherapy makes an impact. In fact, there is evidence that it makes a greater impact than other therapies or medication. I refer to the article “The Efficacy of Psychodynamic Psychotherapy,” by Jonathan Shedler, published in American Psychologist, the journal of the APA, in March 2010. Here is the article’s abstract:
    “Empirical evidence supports the efficacy of psychodynamic therapy. Effect sizes for psychodynamic therapy are as large as those reported for other therapies that have been actively promoted as “empirically supported” and “evidence based.” In addition, patients who receive psychodynamic therapy maintain therapeutic gains and appear to continue to improve after treatment ends. Finally, nonpsy-chodynamic therapies may be effective in part because the more skilled practitioners utilize techniques that have long been central to psychodynamic theory and practice. The perception that psychodynamic approaches lack empirical support does not accord with available scientific evidence and may reflect selective dissemination of research findings.”

    The article also compares the effects of psychodynamic psychotherapy and antidepressant medications, showing that the former provides greater and longer-lasting effects. All findings are based on a meta-analysis of hundreds of studies of the effectiveness of various therapies and medications.

    The article is available at https://www.apa.org/pubs/journals/releases/amp-65-2-98.pdf.
    Well worth a read, Shirah, and worth recommending to your skeptical students.

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