Dr. Mark Goulston is a former UCLA professor who helps high performing leaders, senior management and sales  people reach their full potential using skills he learned training FBI and police hostage negotiators. He is a member of the National Association of Corporate Directors and the Worldwide Association of Business Coaches and writes the weekly Tribune syndicated career advice column, "Solve Anything with Dr. Mark" and columns on leadership for FAST COMPANY and Directors Monthly and is an expert at People Jam. He is frequently called upon to share his expertise with regard to contemporary business, national and world news by television, radio and print media including: Wall Street Journal, Harvard Business Review, Fortune, Newsweek, Time, Los Angeles Times, ABC/NBC/CBS/Fox/CNN/BBC News, Oprah, and Today. Mark Goulston is the author of The 6 Secrets of a Lasting Relationship, Get Out of Your Own Way: Overcoming Self-Defeating Behavior, Get Out of Your Own Way at Work and PTSD for Dummies. For more information visit: www.markgoulston.com.

"Duh?"

In the August issue of the Archives of General Psychiatry a study came out telling us what we in the profession and those outside it have known for sometime. Psychiatrists are prescribing more medications and doing less psychotherapy with patients.

It's unclear whether it's the increased science and efficacy of medications or the market forces especially what gets reimbursed and what doesn't that has caused this shift.

As a psychiatrist, the challenge is that what are called Axis I disorders –such as schizophrenia, depression, bipolar disorder, anxiety disorder, obsessive compulsive disorder and Attention Deficit Disorder—and are treatable by meds cannot be easily separated from Axis II disorders –the personality disorders such as Paranoid, Histrionic, Narcissistic, Borderline—which are more ubiquitous and not as well treated by meds and better treated by psychotherapy.

Unless you gain "buy in" and then full cooperation of a person's personality, they will frequently sabotage the treatment, by not following through or making changes without the psychiatrist's input.

One of the problems is that psychiatrists who prescribe meds have different personalities themselves from ones who do mainly psychotherapy. Prescribing skills often rely on figuring out the patient and then doing a check list to rule in or rule out various Axis I conditions. Patients can often feel like problems to be figured out rather than people to be understood and this can often trigger negative reactions by the patient's Axis II personality disorder acting up.

One of my exclusively medication prescribing colleagues recently told me: "I am responsible for the diagnosis and treatment, I am not responsible for the result." That seemed to say to me, "If the patient doesn't cooperate with me when I'm doing what's best for them, that's not my fault."

This colleague has not apparently learned one of the main lessons in life, that I also believe extends to psychiatric patients, namely "People don't care how much you know, until they know how much you care."

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Update on Aug 5, 2008 by At Basil & Spice

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