As a writer, I know there’s nothing “scientific” about language. It’s all subtle shadings and interpretations. Meaning making. Not exactly the neuroscience that dominates modern psychiatry.

Both Dr. Bob and Dr. Ronald Pies are eclectic in their approach to their patients. Both agree that the causes of mental illnesses are still largely unknown, mysterious and could have any number of causes from trauma, genetics, biology, psychology, environment, in-utero…the list is endless. Both physicians are grounded in a more analytic approach to psychotherapy though they draw on all the latest therapeutic developments ~ long term and short term.

Both prescribe medication, but cautiously and only with meticulous monitoring in combination with psychotherapy. Both believe that medication alone is a very limited way to approach psychiatry.

“Today, Big Pharma has pushed psychiatry towards ‘certainty’.”

Dr. Bob said, “Today, Big Pharma has pushed psychiatry away from ‘ambiguity’ towards ‘certainty’.” He stressed that contemporary psychiatry residents (in Toronto and Canada, probably all over the world) are trained primarily in short term psychotherapies, like Cognitive Behavioural Therapy. Not the psychoanalytical approach he learned.

“There’s a whole menu of short term psychotherapies,” he said, adding that residents must also follow one patient for the long term, focusing on that patient for two to four years of their residency.

“But the reality is that short term therapies are the way of the world, today,” he concluded. Although, he doesn’t practice that way and there are a few other holdouts ~ but not many, as far as I can tell.

I thought about it for a moment.

People must find their own support systems following short term therapy…

“That means people who go through short term therapy must find supports outside the psychiatric model when their therapy is over, right?”

Dr. Bob said, “Right.”

That’s where I felt so badly for so many people left untethered after their therapy finishes and why, now, more than ever before, there’s such a crucial need for other ways of learning and growing. Other ways of connecting and finding help, like here on Psych Central and with all the bloggers, therapists and supports in the community forums here, devoted to helping people find their way to mental health.

That’s where Community Mental Health and Recovery becomes so important. Peer Support. Where the blogosphere is so powerful. People must partner in their own recovery. Must understand that there is no single cure and that health ~ mental and physical ~ demands constant care. The internet is rich in supports, but is it enough? We must find their own way, our own support systems. At times, I can’t imagine how isolating and challenging that must be.

Without someone like Dr. Bob.

At the moment, I’m struggling with my confidence…

“Deep down,” he suggested, when got down to “our” business, “you’re not certain about your self-acceptance. Long ago, you decided you wanted to be different. Now you feel in black and white and you think in shades of gray.”

That dissonance can be unsettling, we agreed, though it’s not unusual.

Psychotherapy is an education slowly diminishing my doubts about my own self-acceptance. I wonder if I’ll ever get there.

When my hour was up, I felt I had so much more work to do. I said so.

“No, not really,” Dr. Bob said. “We’re just cleaning things up. See you next week.”

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    Last reviewed: 27 Jun 2010