I practice psychodynamic psychiatry in a way that's adapted to our times.
This is a place to talk safely, without censure. This can be a very liberating experience, especially for physicians.
Psychodynamic psychotherapy is a deep form of conversation, which can go wherever your mind takes you. It is about the here and now, about what's bothering you in your life, and also about how you got to this point and what you might do about it.
In other words, it's practical, without being forced or restricted by outside pressures, i.e. some insurance mandate.
It's what every physician patient interaction should be, but rarely is any more.
That's it, that the important part. If you've read till here you've read the gist of it. The rest of the page consists of more intellectual type musings.
What does psychodynamic mean?
In a nutshell, it means that we have different layers in our minds, some of which we're unaware of. We're complicated beings, with all sorts of inner and outer pressures and motivations and such. We're not robots. By shedding light on all this stuff that's going on inside us, some of which is in response to what's happening now in the outside world, some, a reaction to things that happened long ago, we can change things. We can change how we feel, how we respond and what we do, if we so choose.
Buddhism and Psychotherapy
Current psychiatric practice, dominated by bio-psychiatry, follows a one person model. According to this model, the patient has an illness, and the psychiatrist is supposed to fix him. The psychiatrist is expected to diagnose the illness and prescribe medications to treat it. This model of treatment is embraced by many, both psychiatrists and patients.
A two person psychology, as seen for example in psychoanalytic psychotherapy, recognizes the interplay between a patient and their therapist and the influence of the observer on the observed. In a broader sense, it recognizes that people are not inflicted with a disease. They suffer from a problem; the human condition. They are stuck in a certain position. It is quite possible to understand the problem, though it can take time. Through this understanding, through the relationship with the therapist, people can get ‘unstuck’, and live a happier life. People can change. One way to bring about change is by a shift in perspective.
Too often, when people are told they have this or that diagnosis, they cling to this diagnosis as an all encompassing explanation for everything that is wrong with their lives. More than an explanation, it becomes a way of life. It becomes a self imposed prison. When people cling to one vision of themselves and can’t let go, they also can’t move on.
In Buddhist philosophy, there is no permanent self. The idea that there is a fixed self is a delusion. And if there’s no fixed self, there’s certainly no fixed ill self. Shedding the attachment to a diagnosis can be immensely freeing. You’re giving yourself permission to get on with it.
It’s like that moment when you first learn to ride a bike. You forget yourself, that self which couldn’t possibly balance on two thin wheels. You forget to fall, you just let it happen – and there you are, riding a bike. Just like that.
Psychiatry focuses far too much on the supposed fixedness of illness, the supposed objective reality of diagnoses, and far too little on letting go. There should be more bike riding in psychiatry.
A word about medications
Most people think that all a psychiatrist is good for is giving medications. Psychiatrists themselves are largely to blame for this, since many embraced this role while abandoning their role as therapists.
Psychiatric medications have been heavily pushed by Pharma and managed care, and as a result are heavily overprescribed these days, without much rhyme or reason. It would be far better to use them in the most minimal way possible, to help with severe symptoms, while seeking relief via all the other methods we have at our disposal as human beings. The seemingly obvious, prudent and common sense way of practicing has sadly gone out of fashion.
You can go to practically anyone with a prescription pad and pretty quickly find yourself diagnosed, usually with 'Bipolar'. Before you know it you're on a long list of psychotropics. More often than not, this is a never ending 'trial and error' where 'nothing works' and you never really feel better. Quite possibly you feel worse off than when you started.
There are, I should mention, some situations where you'd be ill advised to NOT be on psychiatric medications. This is certainly not a blanket condemnation of medications, just a (sadly) unpopular cautious and rational approach to the whole thing.
Psychiatrists are scary
You've decided to talk to someone about your life. Who to turn to? Some people think that the word psychiatrist is scary and that going to see one means that something is seriously wrong with you. Not so!
There's an advantage to seeing a person with broad training and experience. Psychiatrists are in the somewhat unique position, by virtue of their medical training, to have seen people from all walks of life, from the indigent to very high functioning people. We've encountered the whole gamut of human difficulties - and no less importantly, abilities and strengths.
Think about surgeons and this point will be clearer. A surgeon will have operated on people young and old, on very healthy people with a relatively small problem, and on elderly, medically complex patients with complicated surgical problems. Would you refuse to have your simple appendectomy done by a surgeon because 'they deal with really sick people'? It's patently absurd, of course.
The old style psychoanalyst type of psychiatrist, adapted to today, is your 21st century hi-tech, small, local, organic, hand crafted, single batch anything. If Freud were alive today, and if he was a bit less frowny, a bit more chill, then his couch would be a chair, his pipe would be, well, gone, and he'd be Zooming with his patients about the deeper meaning of cat videos.
This is a place to talk safely, without censure. This can be a very liberating experience, especially for physicians.
Psychodynamic psychotherapy is a deep form of conversation, which can go wherever your mind takes you. It is about the here and now, about what's bothering you in your life, and also about how you got to this point and what you might do about it.
In other words, it's practical, without being forced or restricted by outside pressures, i.e. some insurance mandate.
It's what every physician patient interaction should be, but rarely is any more.
That's it, that the important part. If you've read till here you've read the gist of it. The rest of the page consists of more intellectual type musings.
What does psychodynamic mean?
In a nutshell, it means that we have different layers in our minds, some of which we're unaware of. We're complicated beings, with all sorts of inner and outer pressures and motivations and such. We're not robots. By shedding light on all this stuff that's going on inside us, some of which is in response to what's happening now in the outside world, some, a reaction to things that happened long ago, we can change things. We can change how we feel, how we respond and what we do, if we so choose.
Buddhism and Psychotherapy
Current psychiatric practice, dominated by bio-psychiatry, follows a one person model. According to this model, the patient has an illness, and the psychiatrist is supposed to fix him. The psychiatrist is expected to diagnose the illness and prescribe medications to treat it. This model of treatment is embraced by many, both psychiatrists and patients.
A two person psychology, as seen for example in psychoanalytic psychotherapy, recognizes the interplay between a patient and their therapist and the influence of the observer on the observed. In a broader sense, it recognizes that people are not inflicted with a disease. They suffer from a problem; the human condition. They are stuck in a certain position. It is quite possible to understand the problem, though it can take time. Through this understanding, through the relationship with the therapist, people can get ‘unstuck’, and live a happier life. People can change. One way to bring about change is by a shift in perspective.
Too often, when people are told they have this or that diagnosis, they cling to this diagnosis as an all encompassing explanation for everything that is wrong with their lives. More than an explanation, it becomes a way of life. It becomes a self imposed prison. When people cling to one vision of themselves and can’t let go, they also can’t move on.
In Buddhist philosophy, there is no permanent self. The idea that there is a fixed self is a delusion. And if there’s no fixed self, there’s certainly no fixed ill self. Shedding the attachment to a diagnosis can be immensely freeing. You’re giving yourself permission to get on with it.
It’s like that moment when you first learn to ride a bike. You forget yourself, that self which couldn’t possibly balance on two thin wheels. You forget to fall, you just let it happen – and there you are, riding a bike. Just like that.
Psychiatry focuses far too much on the supposed fixedness of illness, the supposed objective reality of diagnoses, and far too little on letting go. There should be more bike riding in psychiatry.
A word about medications
Most people think that all a psychiatrist is good for is giving medications. Psychiatrists themselves are largely to blame for this, since many embraced this role while abandoning their role as therapists.
Psychiatric medications have been heavily pushed by Pharma and managed care, and as a result are heavily overprescribed these days, without much rhyme or reason. It would be far better to use them in the most minimal way possible, to help with severe symptoms, while seeking relief via all the other methods we have at our disposal as human beings. The seemingly obvious, prudent and common sense way of practicing has sadly gone out of fashion.
You can go to practically anyone with a prescription pad and pretty quickly find yourself diagnosed, usually with 'Bipolar'. Before you know it you're on a long list of psychotropics. More often than not, this is a never ending 'trial and error' where 'nothing works' and you never really feel better. Quite possibly you feel worse off than when you started.
There are, I should mention, some situations where you'd be ill advised to NOT be on psychiatric medications. This is certainly not a blanket condemnation of medications, just a (sadly) unpopular cautious and rational approach to the whole thing.
Psychiatrists are scary
You've decided to talk to someone about your life. Who to turn to? Some people think that the word psychiatrist is scary and that going to see one means that something is seriously wrong with you. Not so!
There's an advantage to seeing a person with broad training and experience. Psychiatrists are in the somewhat unique position, by virtue of their medical training, to have seen people from all walks of life, from the indigent to very high functioning people. We've encountered the whole gamut of human difficulties - and no less importantly, abilities and strengths.
Think about surgeons and this point will be clearer. A surgeon will have operated on people young and old, on very healthy people with a relatively small problem, and on elderly, medically complex patients with complicated surgical problems. Would you refuse to have your simple appendectomy done by a surgeon because 'they deal with really sick people'? It's patently absurd, of course.
The old style psychoanalyst type of psychiatrist, adapted to today, is your 21st century hi-tech, small, local, organic, hand crafted, single batch anything. If Freud were alive today, and if he was a bit less frowny, a bit more chill, then his couch would be a chair, his pipe would be, well, gone, and he'd be Zooming with his patients about the deeper meaning of cat videos.
©2023 Daria Inbar M.D.