Should I go to a psychiatrist, psychologist or a psychoanalyst?

Most of our patients are people with an intense discomfort. To get to the consultation have been through many obstacles. The first: take the bull by the horns and face his discomfort and overcome the prejudices of their own, he often thought to refer to a psychological difficulty is manifest as illness, when not only recognize their own suffering and not to give him. Probably also had to overcome prejudices of others, family and friends, motivated by the best intentions, not realizing that the best intentions often lead to a personal hell, and covered with the garb of a so-called conventional wisdom "that each club Support your candle?. And when you can not bear it, or does can only do so at the expense of an oppressive feeling of unhappiness? And if you decide to express their displeasure to the family doctor, chances are that he, overwhelmed by an administration that is also required to deal with mild psychological disorders at the same time, gives 5 'care per patient (clearly inadequate time for a simple check, let alone to encourage the patient to express his discomfort) it ships with a few pills.

If you can overcome these successive obstacles are likely to end up in the already saturated consulting a psychiatrist (a sign that the unrest spreads in our society). She feels bad and expects the psychiatrist a remedy for evil. The Psychiatrist

A psychiatrist is a doctor, except that you have purchased another formation, or psychoanalytic psychotherapy, which is not taught in his career, tend to view psychological distress as any of the conditions of concern to the medicine: a set of symptoms cause organic presumably require a diagnosis and medication. To compare the diagnostic symptoms perceived by the diagnostic categories provided in the manuals looking for the best approaches. This forces us to take a break: the diagnostic manuals ICD (the World Health Organization) and DSM (the American Psychiatric Association, ie North American) were created in order to standardize diagnostic criteria for statistical purposes. In his curious have finally become recipes become compulsory diagnostic application. Their formulas have been widely distributed and not only in professional circles. Today it is common that patients do not consult for their discomfort, but that demand for treatment for a diagnosis that has been previously made by a teacher, friend or themselves, using rich descriptions on the Internet. Not that it is wrong that they are informed, is that they are informed about what?

Looking for the best treatment for a diagnosis, not for themselves, and unique individuals. Waive their personal existence subsumed artificially constructed a diagnostic picture for statistical purposes. It is surprising the increasing ease with which many human beings are persons abdicate to keep to themselves: I am a personality disorder, I am a mood disorder, or even an acronym: I am a TOC, a BPD, ADHD. The psychiatrist, armed with medical knowledge, explores the symptoms the patient presents, performs certain questions protocolized to deepen their inquiry, compares results with the syndromes described in the manual, and set his trial: it is a TOC , a BPD, ADHD. And, under well established diagnostic and his own experience, says he believes the most appropriate medication. Does this work, what is expected of him, and no one else demand. The patient's sayings that do not provide useful information, ie, that fall outside the protocol set are eliminated because they contribute nothing to their knowledge. In many instances the prescribed medication (or successive corrections are made) attenuate the symptoms. On many occasions, but not all.

Many patients lend themselves to this game that hold harmless individual, often tormenting the feeling of being a suffering individual subject, and reduces them to be a disease that disrupts the outside. But not always. In many other cases the subject is not satisfied: the medication is not effective, or not as expected, insists on speaking of a malaise no protocol, does not yield her anguish. This is not surprising: there are very good doctor, very effective, but they are still limited effects pill, no magic potions. The psychiatrist may then, faced with an insistent demand that exceeds their knowledge, opt for a referral to a psychologist (in this case the center or have sufficient clinical psychologists, is known shortages in Social Security, so often limited to more severe cases). It can also be the same patient who has recourse to a psychologist, because who can establish the severity of suffering or dissatisfaction less serious cases?

In other cases, the patient himself his claim input leads to a psychologist, either by the prejudice that associates psychiatry with serious mental illness or because they go in search of a pill to ease your discomfort but a person who will listen, guide and advice from a professional knowledge. The Psychologist

Psychologist or psychologist only indicates that the professional in question has been in possession of a degree in Psychology grant universities, but tells us nothing about the current schools, psychological concepts and guidelines that professional psychotherapy have chosen, and they are very numerous. Chances are that your orientation is behavioral, cognitive or cognitive - behavioral, since they are the mainstream in our faculties, to the exclusion of almost every other alternative. If the psychologist that chance has brought you is predominantly behaviorist orientation (or behaviorist, according to a recent denomination) will try, with the resources of its own, change behavior or conduct deemed harmful by enhancing the positive or negative stimuli (to be understood: rewards and punishments) and other related techniques. If the psychologist is predominantly cognitive or cognitive, will attempt to correct erroneous knowledge of the patient, replacing them with more acceptable and re-establish effective channels of communication. In either case (most likely were combined in what has been called cognitive psychotherapy - behavioral or cognitive - behavioral) will depart from the diagnosis made by the psychiatrist or make a diagnosis based on the same hand.

And apply appropriate therapy at diagnosis, with a protocol, default frequency and duration. The psychologist does not prescribe drugs (not trained to do), prescribed cognitions and behaviors. Is it necessary to clarify that the protocol has been prepared on the basis of diagnosis, which is supposed proper diagnosis, and equally effective for all people who share this diagnosis, regardless of individual differences? In short, psychiatrists and psychologists, the majority (inevitably there are many exceptions, as in any generalization), manage drug therapy or psychotherapy at a diagnosis, not a person. It is somewhat remarkable that in an age that seeks individualistic, individual differences are considered secondary, what predominates is the norm. It is assumed that we can bring together all persons on the basis of the similarity of their symptoms, and they all respond in a more or less evenly to the same treatment. The same patient's personality is fragmented, for better understanding and quantification in various functions: intelligence, memory, emotion ... as if these functions were independent of each other. The person so acting is dissolved altered and preserved healthy and diseased parts. The patient may look comforted by the care you receive, you may find helpful advice received, new ideas and behavior patterns.

But maybe not. This should not be enough, or who resists following these great tips, mainstream thoughts and behaviors that are not proper, but suggested another line with another. It may not be satisfied with the treatment or who have sought alternative entry to the social security system offers. The Psychoanalyst

Let's start with the analysis for several reasons: 1 - As a founding discipline has led to the most current psychotherapies. 2 - By having a long history and a highly developed theory, the point of having an impact on our culture and its manifestations (philosophy, literature, film) known for its "competitors?, Including psychiatry and clinical psychology. 3 - Because it is often the first choice alternative, especially in certain countries (France, USA, Argentina) 4 - Because, paradoxically, one of the disciplines most targeted and least known. For these reasons, we may Insuma more space than the previous sections. To begin to talk about psychoanalysis, either for or against, we must begin by discarding some prejudices: 1 - Weighs about psychoanalysis today being considered by many an ancient discipline, ie outdated. In a Western world that produce and consume new psychotherapies at breakneck speed, many of them ephemeral existence, this implies that if relative antiquity has survived is because many people have found benefit in psychoanalysis over time, clinical outcomes unanswerable so we might consider this more extensive career as a virtue rather than a defect.

2 - psychoanalysis is often confused with its external attributes, widely reported by film and literature: the couch, the analyst quiet, the long duration of treatment. But psychoanalysis can do without both of the couch as the silence, and its duration is only necessarily long in some cases, especially those who aspire to become psychoanalysts. There are other treatments that analysts call rapid therapeutic effect, or targeted applied psychoanalysis, psychoanalysis brief psychoanalytically oriented brief therapy, according to various schools and currents. So what distinguishes psychoanalysis from other psychotherapies the 1 - Psychoanalysis, from its foundation by Freud, seeks to sweep away the rigid boundaries between health and disease. For him no one is quite healthy or totally sick, what suggest some consequences: - To become a psychoanalyst you have to practice psychoanalysis previously analysand condition (ie, patient), a requirement which exists in no other alternative therapeutics. b - The relationship is not between a therapist healthy and a sick patient, but between two human subjects, one of which has been in possession of knowledge which can benefit the other.

c - The method is the same for the healthy and the sick patient and, therefore, for any pathology. d - This method is based on two basic rules: - The patient agrees to everything you say into your head - the analyst to listen carefully to the words of the patient, including accounts of dreams and seemingly absurd occurrences, and return the words a new light. At the same time, ensures that the analytic experience makes sense, by his own experience and that of his other patients. 2 - "Desembaracémonos the average man, does not exist. There are individuals, that's all. When I hear the man in the street, opinion polls, mass phenomena and things like that, think of all the patients I've seen go through the couch in forty years of listening. None is like another and have the same phobias, the same anxieties, the same way to relate, the same fear of not understanding. The average man, what is that? Me, you, my doorman, the President of the Government?

This phrase of Lacan, one of the priests of psychoanalysis, clearly shows the commitment that characterizes the individual. At a time when almost everyone says individualistic, individuals are grouped by psychiatry into two groups: healthy and sick. And the patients are subdivided into multiple syndromes. Many patients are saying about themselves: I am a borderline personality disorder, or ADHD, as if the data summarized their individuality. These diagnostics can be useful for the psychiatrist, because they guide their choice of medication. This does not mean that the analyst does not perform according to their own diagnostic nosology, but their treatment is based on questioning the patient about the causes of their suffering, not a diagnosis or on a protocol. 3 - Therefore, one of the peculiarities of psychoanalytic treatment, in general, psychodynamic, will be the absence of protocol, that is, preset steps. 4 - These singularities make psychoanalysis has been almost always (except a few exceptions) the record. This extraterritoriality of psychoanalysis official state policy in mental health gives certain peculiarities: a - not taught in universities (with some exceptions in France, Argentina and USA).

This gives rise to much of the criticism that has been subjected by other mental health professionals: they have not read in their own training and abundant psychoanalytic texts critical texts (as recognized by the philosopher Gabilondo, rector of the Autonomous University of Madrid and supporter of psychoanalysis). It is often, therefore, a criticism based on ignorance. This does not mean they can not be criticism founded, but most of them are made by people who know the discipline he criticizes. b - The psychoanalytic training is unofficial and independently of university education, but more demanding than her, since it includes, and privileged, the psychoanalysis of candidates to act as analysts, even if they have training and university degree (making it difficult their integration into the formal education), and a much larger theoretical than psychotherapy. For all this, psychoanalysis requires one hand, greater commitment and involvement by the patient and on the other, something that sets it apart from any other alternative psychotherapy: the aim is not subjected to a protocol and its purpose depends on what that the analysand (patient) wants to change in yourself and in your life, so the duration of treatment also depends on your desire.

Note: In the next issue will be referred to alternative psychotherapy.