Why does psychiatric or psychological treatment take so long? It’s because the things that need to be changed are not always so easy or willing to change.
If it’s a straight and pure biochemical depression, then the medications need upwards of at least a month or so to correct the biochemistry and to make shifts in how the neurons communicate with each other. There is even hard evidence that a substance called brain derived neurotrophic factor needs to repair the glia cells, that synaptic receptors change in density, and so on. All this simply takes time. Even if the right dose of the right medication is found from the onset of treatment, the brain initially resists outside influences to change it. This is really a safety mechanism. The attraction of many drugs and of alcohol is that these particular molecules get into the brain quickly and cause immediate effects. But alcohol and drugs do not repair. Medications do. So we have to convince the brain to let them work. The brain is very tenacious in so far as how it hangs onto old ways. Psychiatric medications are really reestablishing, as much as possible, a better or perhaps even a normal biochemical relationship between all the parts.
Sometimes the psychiatric symptoms are not just because of a biochemical imbalance, but because the wiring has been corrupted. Many drugs interfere with the installation, so to speak, around the neurons. When these are damaged, they may not always be fixable. So in this case, the best a medication can do is reestablish as much biochemical balance and normalcy as possible, and then the psychological part of treatment tries to teach the functioning aspects of the brain to work around the damaged parts. A stroke, ilness or injury can cause similar problems.
Sometimes people have genetic characteristics that make them prone to psychiatric problems. This can be conceptualized as a factory with a flaw. Left alone, the factory does not produce the proper products. So the science of psychopharmacology enlists medications to get the parts of the brain that can work to work to what is closer to normal. When this ‘normalcy’ is approached, the psychological treatments then focus on ways to strengthen other parts of the persons makeup so that they can function better. Because of a genetic aspects of the problem do not change, the problem may only be controlled but never fixed. But by the same token, the psychological aspect may become strong enough to mask or even outweigh the influence of the genetic problems. This takes time.
There is also the aspect of biological brain maturation. A 14 year brain is not the same as the 28 year old, so any and all treatments to the 20 year old are being laid onto a very non-static field. (This is the topic of the Adolescent Brain.)
I asked a good psychotherapist why she thought psychotherapy took so long. She said it requires the movement of thoughts and feelings from the brain to the gut. How interesting. The phrase is that we usually trust our gut feelings. She said that many people don’t know how to read their gut feelings, or if they can identify a gut feeling, they don’t trust it, or the situation they live in doesn’t allow them to follow these feelings. Sometimes they are even frightened of their gut feelings.
Psychotherapy is the time-consuming but necessary education of ourselves about ourselves, to understand the way we respond to situations and then to identify, and then practice, ways to change the problematic aspects of our thinking. But sometimes our emotions come from uncontrollable sources outside of our own lives, so psychotherapy may need other people or situations to change as well. If that change is impossible to make, then successful therapy requires that the person learn how to live in spite of it, or to move away.
There is a big difference between understanding a problem and developing the skills, attitudes, and raw experience of how to deal with it. Sometimes these skills and attitudes are part of what we call maturity. This also takes a lot of time to develop, but it also usually takes the ability to try new behaviors, to fail and learn from the failures, and to have a role model to copy. One aspect commonly facing the patient in psychotherapy is the coming to terms with the reality of some situation in their life that is very uncomfortable or disappointing. Another aspect is the coming to terms with the reality of themselves – and it takes time to work into this level of self honesty and the movement away from denial or rationalization. Good psychotherapy is the development of honest knowledge and self-responsibility. As a result, psychotherapy rarely is successful if the person doesn’t want to take this personal, sometimes intriguing, and sometimes painful, exploration to better themselves.
Psychotherapy is not an event. It is a process.
