Psychotherapy as a method of treatment in psychiatry and medicine

Health is not just the absence of disease, but the presence of well-being that includes purposeful and meaningful living that enables personal development. Since Descartes separated mind and body, traditional Western medicine has focused mainly on the mechanics of the body’s malfunctioning.

The main goal of this text is to stimulate thought about the need to understand psychotherapy, as well as the interactive, reciprocal connections between the positive aspects of mental and physical health.

Health-risk behaviors may be largely a story of the pursuit of short-term gratification in a world that offers an uncertain future for long-term investments and aspirations. Unfortunately, compared to the long-term, these immediate pursuits of pleasure and escapism have devastating effects on physical and mental health.

The psychotherapy process is one way to establish a connection between mind and body. True change is neither short-term nor can a therapist advise it, but the client should make an effort through a long-term process to feel psychological well-being through a sense of meaning and purpose of living, and by having self-awareness and the possibility of further personal development and progress.

Psychotherapy is a group of procedures, procedures and methods in the treatment of mental disorders, conditions and disorders that are generally accepted within psychiatry, medicine and beyond. It began to be used as a treatment method exclusively in the treatment of neurotic disorders within psychiatry. Today, its application is widespread and is used in all areas of clinical medicine, in all ages, from very young children to people in deep old age, as well as in all important areas of human life, such as sexuality, marriage, family, academic achievements, work and social success (Lj. Erić, Psychotherapy, Faculty of Medicine in Belgrade 2002).

Psychotherapy is carried out in special circumstances that are an essential and integral part of the therapeutic process, which is not only of a technical nature but also has significant therapeutic effects (setting). A psychotherapist can be a person who has graduated from university, with a humanistic orientation (medicine, psychology, pedagogy, sociology). In order for someone to have the skills to lead the psychotherapy process, he should be additionally educated for some of the directions in psychotherapy (dynamic, cognitive-behavioral, humanistic-existentialist-phenomenological, integrative and sociotherapeutic). The educations are long-term (4-5 years, depending on the direction) and participants can work when they are under supervision, that is, when their work in conducting the psychotherapy process is monitored by a mentor.

Considering the current situational circumstances and times of crisis, there is an increased need for people to help themselves. There are a lot of psychotherapists who “offer their services” online or psychologists, psychiatrists who are not trained to lead the psychotherapy process, but do it intuitively, without mentoring. Such a patient-therapist relationship is only at the level of support and does not take the form of a psychotherapeutic process that requires clearly defined conditions.

The patient and the therapist meet in special conditions – always in the same space (live or online), at the same time. Sessions last 45-50 min (individual therapy) or 90 min (group psychotherapy), once or twice a week. They can be performed in outpatient settings (private practice, polyclinics, outpatient clinics) or in hospital settings (inpatient or day hospital).
Patients/clients can come for treatment on their own initiative, on the recommendation of general practitioners or doctors of other specialties (cardiologists, gynecologists, urologists, endocrinologists…) or on the suggestion/pressure of relatives, friends, spouses or work organizations and, finally, by another psychotherapist. , who, for various reasons, assesses that a certain therapist could help the person more and better.
The psychotherapeutic process does not exclude or necessarily include taking pharmacotherapy. Good practice is that a doctor, a psychiatrist (may or may not be trained in psychotherapy), prescribes drugs, and another psychotherapist (psychiatrist, psychologist…) leads the psychotherapy process.

Whether someone will come for psychotherapy treatment depends on the attitudes of the doctors who refer the patients for treatment, the attitudes of the family that can support the treatment or, on the other hand, make it impossible or even prohibit it, and finally on the cultural environment in which the person lives. More often, people aged 20 to 30 years opt for the psychotherapy process. They have the most capacity for change and their life period is inherently vulnerable (schooling, relocation, separation, possibly starting a family).

Teenagers between the ages of 14 and 18 are increasingly asking for help, because information is available to them, and they can more easily recognize their disabilities and seek help. Parents often do not support this need of the children, believing “that they can help them themselves… that it is a short-term crisis and that the children should make an effort on their own because the problem is in their head”.

Non-support is also connected with cultural principles, deeply transgenerationally based because they did not solve the problem themselves with the help of psychotherapists. I believe that it is important for parents to provide support to the child, that is, to the teenager, to share their developmental difficulties with an educated and competent person, and to build adequate mechanisms within themselves and support systems in the environment in time.

In our environment, the most common are problems with nutrition, impulsivity, and controlling feelings of anger, the need for an external locus of control, and a decrease in previous cognitive competencies. Group therapy is recommended for this vulnerable group, because they have a developmental need for peer support.

Dr. Ana Zivanović
spec. psychiatry