We often have wrong beliefs and doubts about which psychotherapy is best for us to treat depression. Learn about the differences between psychology, psychiatry, and psychoanalysis and what to expect from each of them.
There are few people who, after having visited a psychiatrist, complain that they could not express everything they felt. Carried by the images of movies and television series, in which the psychiatrist sits in front of the patient and maintains an interlocution between the two, they believe that this is the common model, not only of psychiatry, but of any psychotherapy. This belief is partly right, but it must be reviewed and differentiated.
A LITTLE HISTORY
The confusion between psychiatry, psychology and psychoanalysis comes from the fact that, historically, they have converged at certain times.
Let us remember, for example, that Freud was a neurologist and that his first works were on the functioning of representations that followed circuits similar to neurons. Then he would abandon that idea and focus on how the subject, through certain identifications with his environment, reproduces his unconscious complexes when faced with conflicts. This was the beginning of psychoanalysis, a perspective that infected and enriched an incipient psychology whose basic scheme was the reactions in animals.
Thus, was born, on the one hand, what has been called dynamic psychology, which with psychoanalysis expanded its vision of the human. On the other hand, it gave rise to the psychology more attached to cybernetic models, cognitivism, which understands that between reality and the subjects there is a mental scheme that can be wrong and that would be the cause of psychic dysfunctions. The path that psychiatry followed was divided in two:
On the one hand, those who combined dynamic psychological therapy with the new substances that were emerging to alleviate anxieties, insomnia, etc., but whose fundamental work is the word.
On the other, psychiatry called “biologist”, which assumes that the origin of mental disorders would be in genetics or in a deficiency of biochemical substances in the brain, such as serotonin or lithium. In this biologism, an attempt would be made to compensate for deficits by prescribing and administering psychotropic drugs such as antidepressants or antipsychotics.
The latter is the psychiatric pattern that has been increasingly imposed and the one we have in Spain in public health and in most private health. Although we can find exceptions.
WHICH PROFESSIONAL SHOULD I GO TO?
With this scenario, the key question would be which professional to consult in case of mental problems. In order to answer, we are going to clarify what can be expected from each of them.
WHAT TO EXPECT FROM PSYCHIATRY?
If we visit a psychiatrist (usually a biologist) for depression, what will interest him are the symptoms, that is, if we are sad, we have anxiety, we sleep badly, if we have felt this way for a long time and if this state unable to work or socialize.
From there, he will make his diagnosis by referring to a Manual of Mental Disorders, the DSM. Once the category is located, it will proceed to prescribe the substances indicated for that pathology, which are usually antidepressants, anxiolytics and sleeping pills. The follow-up that is done consists of adjusting or varying the doses or brands depending on how the patient is assimilating these medications. These drugs usually take effect after about fifteen days and what those who take them report is that they create a kind of barrier in the brain through which things affect them less, as if they slip more. It is also true that, in some cases, this passive effect makes them feel more forgetful and that, for that reason, they believe that their condition has worsened.
This type of psychiatric approach, by itself, and by not going to the triggering causes of the depressions, increases the probability that they will recur in the future.
WHAT TO EXPECT FROM COGNITIVE BEHAVIORAL PSYCHOTHERAPY?
If we opt for a cognitive-behavioral psychotherapy, the psychologist will want to know the wrong mental schemes that have led us to depression. They speak of a vulnerability factor to refer to people who have a tendency to depression or other pathologies, because they have built a false vision of themselves.
The main method is based on contrasting with reality each of the complaints that the patient may have, in such a way as to be able to replace that bad image with a positive one. The tasks consist of confronting the feeling of incapacity that the person claims to have with jobs or situations that the subject is capable of carrying out. The therapist will underline the successes achieved and, in this way, the person will look and feel better about himself.
The objection that could be made to this method is that it focuses excessively on a single mental issue, so it does not cover all the stressful situations that a person has to face throughout life. On the other hand, and along the same lines, being an overprint on previously fixed mental schemes, this new composition does not get blown up when confronted with other types of experiences or symptoms.
WHAT TO EXPECT FROM PSYCHOANALYSIS?
The psychoanalyst is interested in everything about us. Moreover, its main rule is free association, which means that the patient goes on saying whatever feeling or idea comes to mind. After this apparent disorder, but in which there is a pattern of repetition in different areas of his life, the person will be expressing the identifications of the self with the figures of his environment, in addition to the part of himself that has been trapped, entangled, in those first identities.
This happens in a more or less conscious way for the patient and, when faced with depression, one can hear complaints such as not being a good mother, not having achieved professional success, or having achieved it but not having a partner, or not being successful. a family as God intended. The ideals and self-demands are usually linked to those promoted by those close to them, or the contrary, and those that are part of the desires that have been able to motivate certain vital choices are dismissed. Being able to untangle and reposition all these feelings produces an effect of liberation from the heavy burdens of the past, in addition to seeking a greater knowledge of ourselves.
This method works not only so that depression disappears, but so that the person has their own tools against different moments and circumstances in the future.
Long-lasting psychoanalysis is objected to. However, the decision to go deeper will always depend on how far you want to go, once the symptoms that led the person to consultation have disappeared.
Finally, it must be emphasized that if the phenomena that appear are hallucinatory, delusional or persecutory, we may be facing a psychosis. In these cases, any of the above professionals can be consulted, but it may be necessary to go to the psychiatrist so that, with psychotropic drugs, he can stabilize acute crises and work on psychotherapy through words.