Conservative Therapy Vs. Medication

[HappyJock]

I started therapy in November; I like my social worker a lot. Although an intern, she's one of the best I've had the pleasure of working with. However, she's leaving so I set up an appointment with a new clinic where I met the new social worker and psychiatrist. I told my first social worker (intern) about wanting to see her twice a week and she says:

S. Intern: Okay, well, I think you should try using some methods to cope alone. (Mind you, it's only been a month of being with her and she's not seeing me more than once).

New social worker: "Oh, sure! I truly believe in conservative therapy; your PTSD doesn't diagnose you and doesn't mean we have to dope you up with drugs in replacement of more therapy. Try therapy at least twice a week, if not three. Then, if you feel like your symptoms are running, you can consider medication. It's all about truly re-living what happened once more, in a safe place, here, so you can finally distance yourself properly. I don't think just once a week is significant enough for it to be okay to give you medication as well."

What's your take on it? My psych. said the same thing; go to therapy more, then, as your SW sees how you're doing, we can give you a minimal dose and increase it if need be. But you going once a week doesn't make sense; of course you will ask for medicine. Communication is important, as you don't do it a lot during the week outside of therapy, it seems and you need to first learn that here so you can eventually decrease therapy and use those methods outside when ready.

What's your experience between the two? Which helps you more? Meds and talk therapy once a week, more than once a week and a little medicine, etc? I understand everyone's PTSD is different, but this is just a thought I'd like some opinion on.

 

[twinkle30]

Well let me start off by saying I have more than one diagnosis. I have schizophrenia and ptsd. For my schizophrenia I have to take meds and talk therapy won't do a thing. For my PTSD I find that therapy works best. Using the coping skills my therapist is teaching me I don't even have to take my anxiety pills anymore. So in other words it depends on what you have and what works best for you.

 

[Crow]

If you can afford the multi day a week sessions with a qualified trauma specialist, go for it. My pdoc/T took me off of meds years ago. Actually she told me to come off meds a year before I felt comfortable. When I finally stopped, the first year was rough but life has been better....harder but better. The key is trauma therapy with someone trained specifically in treating ptsd.

 

[LuckyDuck]

Through therapy you will have a great deal of understanding of yourself. The level of understanding will be coupled with your stengths and if meds help, it's better than no therapy and just meds. I'm on one med and therapy, compared to a decade ago of a pharmacy.

Best of luck to you!

LD

 

[Chosen]

I do best with biweekly therapy appts, but I'm not on meds either. When I had most symptoms, weekly therapy helped, and crisis appts as needed. Now I don't need that.

 

[Justmehere]

If you are not functioning well, or engaged in unsafe behaviors, then meds are something that may be needed, no matter the number of sessions a week.

If you are able to survive your day, and are not a safety risk to yourself or others, then it's ok to hold off on medications.

I am not sure about the goal of therapy to be "reliving" the trauma. That is typically seen as therapeutic. It's more like processing the trauma, with one foot in the past, and one foot in the present. It's not about reliving it. That's both feet in the past and tends to just make symptoms worse.

I disagree that adding more sessions is always a route to stability. If the extra sessions are spent on coping skills, and not processing trauma, then yes, extra sessions can help stabilize. But if the extra sessions are done as more sessions to relive therapy, then it should be expected that symptoms will get worse.

What I think she is getting that, that is a healthy and good standpoint, is that trauma therapy is about feeling your feelings and being able to cope with them. The feelings of the trauma, and now, and working it through using one or another trauma therapy technique. Medications can either help or hinder that process. Some meds help people actually feel more. Some meds don't. Some people need meds to regulate emotions so they can manage some of the hard work of therapy and still function, some use meds to escape the pain and escape hard work in therapy.

That all being said, studies have shown that the single biggest factor of therapy helping someone is not actually the frequency or the type of therapy. It's the relationship between the client and therapist, the quality of the therapeutic alliance. This doesn't mean that the relationship is easy or one that always makes the client feel happy. If the therapist and client don't click well, and they are not able to work through and talk through issues that come up along the way, then it won't matter what meds someone takes or how many sessions a week someone has - it will be harder to get better.

The intern is right too. Working on coping skills on your own is also an essential part of therapy. It's not an either/or matter. It's that maybe extra sessions will help, but it should also mean that it comes with extra work on your own. Same with meds. Medications may help, but that should also be coupled with even more work to use coping skills on your own. The intern may have been picking up on perhaps some possible avoidance you may have to doing that work, and maybe that is why she suggested it. She also is just an intern, and maybe didn't know extra appointments are possible.

As you sort this out, keep talking to the new therapist about it. Work it out in that relationship - because it's not a detour from the work, its a part of the work itself.

 

[EveHarrington]

I don't think that reliving your trauma in therapy is a good thing, no matter how many coping skills you have or how well you're able to ground yourself. If you relive your trauma, it's inevitable that your emotions will be running the show and if your emotions are overpowering everything else, processing will be quite difficult. Do you know what your therapists approach to processing is?

 

[barefoot]

I only do therapy (once a week) - I don't take any meds.

Agree with some of the others here - I don't think "re-living" your trauma is generally the aim. I have accidentally managed to get retraumatised in therapy sessions a couple of times and it's a deeply unpleasant experience, which has had significant repercussions for many days afterwards. So deliberately trying to "re-live" trauma sounds like an irresponsible approach to me because I can't see how that wouldn't be retraumatising.