Philosophy of Treatment? That should be simple and exactly the same for every physician, no matter their specialty: To accurately make a diagnosis and render evidence-base, scientifically sound treatments that are effective for that diagnosis. And that is certainly what I do, but I think we can go into more detail of what “Philosophy of Treatment” might mean.

Unfortunately, in this day in age psychiatrists are often less involved in psychotherapy and many times not at all. In fact, I have sometimes heard psychiatrists defined as “they give out medication and don’t do psychotherapy.” I cringe when I hear this for two reasons. Number one: it is often true. Number two: it is not true of me and I don’t want people to think that way about all psychiatrists.

In decades gone by, psychiatrists were the main providers of psychotherapy. Most of the great names in psychotherapy of the past century were psychiatrists. Over time, that began to change for several reasons. Fifty years ago, we had few psychiatric medications and most of psychiatry was involved with psychoanalysis as the main treatment for whatever your issues were. With the incredible advancements in neuroscience over the past several decades, our understanding of the brain greatly increased and with it more ways to effectively treat depression, anxiety, panic disorder, obsessive-compulsive disorder and others.

If you looked at the table of contents from an issue of The American Journal of Psychiatry in the 1960’s or 70’s, almost every article would be pertaining to psychotherapy. If you look at a current issue, virtually all of the articles will be about biological treatments. This is not all bad. It speaks to the awesome revolution in neuroscience advancements that show no signs of slowing down. This is very good.

However, in our excitement about synapses and brain receptors, we cannot forget and we should never underestimate the power of psychotherapy. During my residency in the late 80’s, there were still many professors who spent their careers doing psychotherapy primarily and I was lucky enough to have received an extensive experience in the practice of psychotherapy in its many different forms.

I have many patients where I do the medication monitoring and I work with a competent psychologist or social worker who does the therapy and we work together as a team. I have many patients where I do the psychotherapy and the medication monitoring. I have patients who are only on medication and don’t need psychotherapy and I have patients who I am doing psychotherapy with and need no medication at all. My point is that everyone is different. One size does NOT fit all and each patient needs a different “treatment plan.”

Let me give you an example. Two patients come to my office with almost identical problems: over the last year or so they have developed a driving phobia that has worsened to the point where they cannot drive to work and are about to lose their job because of it.

The first person is a 35 year old woman who has been rather anxious her whole life and over the past year her anxiety has manifested as a driving phobia. I explain to her