Articles | MY CLINICAL PHILOSOPHY

MY CLINICAL PHILOSOPHY

INTRODUCTION

While practicing and teaching psychology I have been asked various questions concerning the fields of psychology/psychiatry. I have tried to give clear, straightforward and truthful answers to these questions, so that people may become more knowledgeable concerning this field. Sometimes, there is no definitive answer to certain questions. That is, our current scientific knowledge does not permit the formulation of substantiated, proven theories. Consequently, we’re limited to hypotheses (i.e., educated suppositions/”guesses”), which need further study. For example, we have hypotheses which may address the question: “What causes depression?," but as yet there does not exist a scientific consensus on this subject. Perhaps the answer is that many things can actually cause depression, just like many things can cause cancer. Some subjects are more esoteric and nebulous. Consequently, we may never reach a point of complete scientific consensus. An example of this kind of ‘hard to answer’ question might be: “How exactly does the “mind” (i.e., the brain) affect the functioning of the physical “body?” As human beings we crave definitive answers to life’s questions and issues and depend upon scientists to provide truthful information. However, part of speaking the truth invariably involves sometimes saying we don’t really know the answer to a question. I like to consider myself a scientist as well as a clinician. I am also not reluctant to give the answer “I just don’t know,” when questions are asked for which I do not believe anyone has come up with a proven answer. Of course, I have educated opinions about certain questions but these are just that: opinions based upon my own clinical experiences and study. However, offering a studied opinion is different from “throwing the baloney” and acting like I have all the answers, just because there is the word “Doctor” in front of my name! (I try to slap myself really hard whenever I act that way.) In summary, I’m happy to offer opinions on issues and tell you what I think, but I try really hard not to be a “baloney thrower.” In light of this introduction I have decided to write a regular column for my website which attempts to address some of the key issues and questions I have encountered over the years. Today’s column is the first offering of this new feature on my website. I hope you find this interesting and informative! My best wishes! Michael Gallo

MY CLINICAL PHILOSOPHY

I have frequently been asked to describe specifically how psychology and psychiatry can help people deal with problems and lead healthier, happier lives. In essence, people want to know what techniques and tools of psychology/psychiatry can actually help to make a difference in people's lives. For instance, dentistry can remove a decayed, inflamed tooth and replace it with a crown or implanted tooth. Antibiotics can cure a bacterial infection in the lungs. What can psychology and psychiatry do? Darn good question. There are probably 10,000 answers to this question but here is my opinion. In my years of clinical practice I have come to the conclusion that certain things work to improve the health and quality of a person’s psychological life. Here they are in a nutshell:

1. Helping people change their behavior.

If we can change the way we behave (i.e. act), this will inevitably lead to changes in the way we feel emotionally. Most people think we need to feel differently before we can actually start to act in a different manner. This is not so. If behavior is altered, then it will inevitably ‘pull’ our emotions in a more positive direction. We see this very clearly in the treatment of depression and anxiety. When a person is depressed they often feel like they do not want to engage in constructive or recreational activities. That is, they have no emotional desire to go out with friends to the movies, work on their hobbies, etc. However, if they compel and force themselves to do these things anyway, they will find that they begin to experience some positive reinforcement, pleasure and satisfaction. At the very least they will find that their depression is less intense than if they stayed home and did nothing. In essence, forced behavioral change is a good anti-depressant. There are many other behavior-oriented techniques, which can effectively treat even the worst clinical depressive illness. Behavioral change also works to combat anxiety. If a person avoids a certain place or situation because it causes them anxiety, they simply tend to reinforce their fear of that stimuli. If instead, they force themselves to be exposed to that anxiety-provoking stimuli, they will notice that they eventually desensitize to the situation. Once again, emotions change because the person first engaged in positive behavioral change. The act of behavioral change is the effective principle behind a type of treatment called “Behavioral Psychotherapy.” In the hands of a skilled psychologist and a motivated patient it works very well for a number of psychological problems.

2. Helping people change the way they think.

There are three types of psychological phenomena: behavior, feelings and thinking. While feelings are not accessible to being changed at will, we can indeed ‘will’ ourselves to change our behavior and thinking patterns. By changing our behavior (as we discussed above), as well as our thinking we can in fact have a major impact upon our emotions. An experienced psychologist can help one learn how to identify and change negative, irrational thinking patterns which can lead to or exacerbate problems such as depression or anxiety. One can actually learn how to ‘think’ differently. That is, while we are seemingly victims of ‘automatic thinking,’ a person can learn to identify, analyze and challenge unreasonable and erroneous thoughts. Just as changes in behavior can positively affect emotions, so too changes in thinking can affect the way we feel. This particular type of treatment is known as “Cognitive Psychotherapy”. Taken together, cognitive and behavioral psychotherapy can have a major positive impact on such conditions as depression, anxiety disorders and even substance abuse and dependence.

3. The development of insight.

Psychotherapy can help people develop important understanding of their inner self. This introspection can uncover what lies behind our behaviors, emotions, cognitions, motivations, needs, wants and self-image. Each of these ‘intrapsychic’ factors has a major impact on how we feel and how we interact with other people. Before we can change ourselves we must first understand ourselves. Thus, insight into who we are is an essential component of any psychological ‘cure’.

4. The attainment of a scientific understanding of what is causing us to feel badly.

Knowledge is indeed power. We fear most that which we do not understand. Therefore, accurate psychological diagnosis and in-depth understanding of the scientific facts regarding a disorder are an essential component of any treatment. This is what we call ‘psycho-education’. Many patients report that they feel significantly better after they obtain a thorough understanding of what exactly is going on inside of them. Education about a particular psychological disorder and understanding that it may be relatively common, can ‘normalize’ things and provide significant relief.

5. Emotional “processing” and psychotherapeutic support.

Sometimes we just need to talk with someone who is objective, empathic and knowledgeable concerning the issues we are facing. Doing this can make us feel less isolated and more normal. Just finding out that many other people are experiencing the same problem, makes us feel better. Moreover, some issues and concerns need to be carefully analyzed in great detail (i.e., processed) so that we can understand the exact nature of what is troubling us and how this problem originated. Significant emotional benefit results from these straightforward but very potent psychotherapeutic endeavors.

6. The development of wisdom.

Wisdom is much more than just being smart. Wisdom involves the practical application of intelligence to life’s problems and challenges. It also holds that the search for truth is a sacred endeavor. Moreover, wisdom goes hand in hand with the application of philosophy in a person’s life. Philosophy deals with the ‘really big’ questions in human existence: for example, “Who am I?” “What is my purpose in life?”, “Where am I going after this life?”, “What do I need to do in order to lead a good and happy life?.” The answers to these questions are different for each of us. Furthermore, if we do not grapple with these questions and come up with answers which work for us, we will feel dissatisfied, empty, anxious and depressed. Intelligence, thoughtfulness and most importantly, wisdom help us wrestle with these ‘really big’ questions and develop workable answers, which guide us throughout our lives. I believe strongly that psychotherapy must address important philosophical issues and help us develop and apply wisdom in all areas of our life.

7. Judicious use of medication

This is not my specialty area and I do not prescribe drugs myself. However, I do believe that medication can have a helpful role in the treatment of psychological symptoms and problems. Having said this I need to add a qualifying statement: in my opinion medication is at times over-emphasized by some doctors and patients and seen as a panacea or “cure-all” for whatever it is that ails us. Medications can play a vital role in the amelioration of psychological conditions such as depression, obsessive-compulsive disorder and panic disorder. In fact, medication is absolutely essential in the treatment of severe mental illnesses such as schizophrenia and severe bipolar disorder (a.k.a. manic depression). But for the average person who seeks psychological help, medications may not be essential, except perhaps to “take the edge off” the more intense symptoms. This can then allow the individual to engage in the work of psychotherapy more effectively. However, I don’t believe that the complete, “magical” answer to most of life’s problems and troubles lies inside of a pill.