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  • Writer's pictureMark Ragins

Integrating Medications and Psychotherapy

Updated: Mar 24, 2021

Integrating Medications and Psychotherapy

Mark Ragins MD

For my entire career, since the ascendency of DSM 3 and the demise of psychoanalysis in the late 1970s, we have been working within an illness-centered medical model paradigm that goes something like this:

Certain defined symptom clusters indicate the existence of underlying mental illnesses in the brain due to chemical imbalances that medications can correct. When someone is in distress they may be experiencing a situation difficulty, or even a crisis, and they can be helped with therapy or counseling (“working through it”), unless they have enough symptoms to make a diagnosis, in which case they have an illness that should be treated with medications. If their distress is long-term emotional, perhaps childhood or trauma related, then they should be in longer term therapy unless they’re suffering from an underlying diagnosable biochemical mental illness in which case they should be treated with medications too. If someone is “stuck” in therapy that may mean that they have an underlying biochemical illness and that’s why they’re not progressing and they should go to a psychiatrist to be diagnosed and medicated. If they are using drugs or alcohol on an ongoing basis, that distorts the picture and undermines medications and even can make medications dangerous, so they should be clean and sober before we attempt to diagnose and treat them. Diagnoses are made upon the basis of symptom clusters, which can be objectively observed by a professional independently of the person’s unreliable, subjective experience. Similarly, treatment can be ordered and its efficacy tracked by professionals using objective criteria.

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