Talk Therapy & Psychopharmacology: Is one really better than the other?


“As a senior in high school, I have seen the need for mental health care become more prevalent as people begin their transition into college and prepare for their future.”

One thing that has guided my research has been seeing people struggle to stay motivated and invested in their future as they battle overpowering obstacles like depression and anxiety. From this, I think finding an effective method to facilitate mental health care is extremely important. My ongoing interest in the brain and its inner workings, combined with my desire to help people, encouraged me to intern and conduct research at Create Outcomes.

As I read over articles, a consistent theme that I noticed was that we all have an inner desire to be loved and accepted in our relationships with other people. Understanding this, I can see so many useful applications for the qualities of a therapeutic relationship inside and outside of psychotherapy that can help encourage people in their path towards better mental health.

With an estimated 19.2% of adults in the United States seeking out mental health services each year, the need for effective care has increased as people are having to face the prevalence of mental illness in their daily lives (Centers for Disease Control and Prevention [CDC], 2020). The most sought after treatment approaches include talk therapy and psychopharmacology. Talk therapy, or psychotherapy, uses a combination of psychotherapeutic methods and theories in order to increase overall psychological, mental, emotional, and even physical well-being. For example, widely used therapeutic modalities, such as cognitive-behavioral therapy, relational therapy, and psychodynamic therapy all use different approaches to help the client improve upon and learn more about themselves, as well as help them understand how they fit into the world around them.

Psychopharmacology, on the other hand, is the use of medications to help treat diagnoses such as anxiety and ADHD, as well as more complex psychiatric disorders like depression, schizophrenia, and bipolar disorder. While both interventions can be effective in treating mental illnesses, the very strict and mechanical manner of psychopharmacology lacks some of the more empathetic qualities commonly found in talk therapy (Shafti, 2019). Here, I believe that the connection between the client and therapist creates an atmosphere where more can be accomplished than by the singular use of psychiatric medication. So, while psychotropic drugs offer beneficial outcomes, I believe that it is important that psychotherapy is highlighted as an equally essential treatment for mental disorders.



In the last couple of years, breakthroughs have been made in the field of neuroscience that have given us a better understanding of the brain and its behaviors, which has provided merit for the use of psychotropic drugs. Here, psychotherapists and psychiatrists alike are now able to better understand some of the more chemical causes of mental disorders, and can address them in a way that utilizes the physical aspects of the brain and its structure.

A major idea that has come about in the wake of neuroscience is neuroplasticity, which is defined as the ability of the brain to adapt its structure and functioning in response to experience. This process of change is specifically known as long-term potentiation, where high frequency stimuli increases the functionality of neuronal synapses (Malhotra & Sahoo, 2017). Essentially, as the brain is introduced to new experiences and unprecedented physical change like that of a traumatic injury, the connections in the brain change and reorganize in order to adapt their responses to internal and environmental stimuli.

Taking this information into account, it can be said that some psychiatric disorders commonly result from “underdeveloped, under regulated, or under-integrated” neural networks caused by unnurturing environments, physical damage, chemical imbalances, etc. (Malhotra & Sahoo, 2017). The purpose of psychotherapy follows, in that it “attempts to modify or change [… ] neural networks” (Malhotra & Sahoo, 2017, 3). While not a chemical alteration, psychotherapy can help alter negative thought patterns by helping the client change negative behaviors, and create more positive outlooks.

From this, the therapist can possibly take advantage of neuroplasticity by changing the brain at its most fundamental level, where thoughts and emotions are constantly shifting in response to the surrounding world (Shafti, 2019). For example, talk therapy can be considered a “rebuilding” experience where the client’s expectations are constantly broken down until, ultimately, their way of thinking can be changed on a behavioral level. In comparison to psychotherapy, psychopharmacology tends to focus on the alleviation of symptoms, and even though psychotropic drugs do alter the brain at a chemical and structural level, the client is unable to take active action by just taking medication alone. Additionally, even though psychopharmacology does utilize neuroplasticity on a chemical level, it can be said that it makes it hard for the client to monitor their own progress, and their ability to grow by themselves is overshadowed by the reliance on psychotropic drugs.

Stemming from this, I believe that an important part of therapy is the therapeutic relationship, which allows the client to grow in a positive way as the therapist uses affirming methods to ensure the mental well-being of the client. Without the emphasis on the therapeutic relationship, it is possible that the clients’ improvement can falter due to a lack of engagement with their therapist, which can lead to reduced engagement with progressing towards recovery. Although psychopharmacology is an effective method to use with disorders that require more biological regulation, there is “a lesser amount of emphasis on patients’ accountabilities to play a part in their own treatment” and the therapeutic relationship can be diminished (Shafti, 2019). While effective, we have to ask ourselves what motivating factors remain once the symptoms are reduced.

We all know that the core competencies that underlie the therapeutic relationship are acceptance, accurate empathy, positive regard, genuineness, focus, evocation, and hope (Miller & Moyers, 2021). These factors all serve to help the client understand their individual worth, which then creates an environment where the client can take an active part in their recovery, and can find legitimate hope that they can accomplish their goals.

Additionally, with the absence of these necessary qualities in psychopharmacology, the client may not be equipped to take the extra steps to integrate coping mechanisms in order to make tangible changes and have a sense of autonomy. To illustrate further, “studies have…found that a counselor’s therapeutic skills predict client outcomes,” not necessarily just the specific method or theoretical orientation used (Miller & Moyers, 2021). So, while these therapeutic skills in psychopharmacology are not as present, the client does not receive all the possible benefits, and although psychopharmacology has been shown to be just as successful as psychotherapy, the combination of both methods, I believe, can be the most effective, and reaps rewards that should not be overlooked during the client’s journey towards better mental health.

Overall, psychopharmacology has its uses and can be very successful. Underemphasizing the importance of psychotherapy, though, would be a mistake in the treatment of mental disorders. It is in the client’s best interest to receive a variety of methods so that they can experience more benefits from working hard to improve their mental health, and so that they can consistently expose their brain to new ways of thinking and learning. Moreover, human connectedness is powerful in itself, and when adding it in the form of a healthy, therapeutic relationship, clients have a better chance to reach their goals. A cure for many psychiatric disorders is hard to come by, but by utilizing knowledge about the brain and every individual’s need to feel their worth, steady improvements can be made.

Chloe Cole is an intern at Create Outcomes. She graduates high school in the spring of 2022 and plans to study psychology.

References

Centers for Disease Control and Prevention. (2020, September 23). Products — data briefs — number 380 — september 2020. Centers for Disease Control and Prevention. https://www.cdc.gov/nchs/products/databriefs/db380.htm.

Malhotra, S., & Sahoo, S. (2017). Rebuilding the brain with psychotherapy. Indian journal of psychiatry, 59(4), 411–419. https://doi.org/10.4103/0019-5545.217299

Miller, W. R., & Moyers, T. B. (2021). Effective psychotherapists: Clinical skills that improve client outcomes. Guilford Publications.

Shafti, S. S. (2019, March 27). Pharmacotherapy vs. psychotherapy: An educational challenge in current psychiatric training. lupinepublishers.com. https://lupinepublishers.com/psychology-behavioral-science-journal/fulltext/pharmacotherapy-vs-psychotherapy-an-educational-challenge-in-current-psychiatric-training.ID.000133.php.

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Create Outcomes is an organization devoted to supporting individuals in growing toward their highest potential. We offer individual therapy, couples therapy, group therapy, therapy for children, teen therapy and retreats. Our therapists integrate psychodynamic theory, cognitive behavioral approaches, and their own unique perspective and training to provide the most clinically relevant care to each individual. We are in-network with Humana insurance and offer in-person therapy in Denver, Colorado, New York, NY and Long Island, NY and provide teletherapy for residents of Florida.

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