What Works in Counseling, Psychotherapy, and Psychoanalysis: Keep the Hardware in Mind

Advances in psychopharmacology coupled with my professional experience treating patients who have problems with anxiety, attention, and mood led me to appreciate how medication can play a necessary but not always sufficient role in helping patients achieve their treatment goals. Although as a psychologist, I am not licensed to prescribe medicine, I know from experience that psychopharmacology can be an important component in my work with patients. Accordingly, I have developed close professional relationships with psychiatric physicians who can assess my patients for the extent to which medications are appropriate in their particular circumstances. Psychopharmacological interventions can defragment or optimize their hard drive, but alone cannot rewrite cognitive and behavioral software code. That is the job of psychoanalysis and psychotherapy. In fact, I do not think that counseling – usually a shorter-term and very goal focused engagement with a therapist – does much comprehensive software re-writing. However, it can provide much needed support in times of acute crisis, and teach people new coping skills. Psychotherapy and psychoanalysis provide opportunities to address both broader ranges of problems in living and examine the kinds of stuck spots when patients want to change but seem unable to do so, possibly due to previous and forgotten life experiences that when remembered accurately make clear why to change is so dangerous.