I first of all I wish to highly commend Mary for disclosing her experiences to us. I am sure that was not an easy process and it suggests that she has great courage and strength!!!!   

I believe that segments of Mary's letter referred to some comments I made in a posting on OCD and hence, I have decided to post again. 

Please remember that the objective of my posting was to provide information on additional methods of assessment and treatment other than the medical assessment and  pharmaceutical methods that had been discussed in earlier postings. I quote ...
" I thought that I might provide another perspective to both assessment and treatment."

As clinicians it is important to be aware of all options in order to truly see the reality that our clients present as well as to provide our clients with optimal information and referrals options.

My personal background is medically based, including experience as a psychiatric nurse on an in-patient floor. However, my post graduate training as a psychotherapist opened my eyes up to a whole new way of looking at what I had previously thought could only be defined as  "disorders, syndromes or diseases". I learned that in many cases there are other ways of understanding the client's reality. Through caring and client centered supervision I have learned to integrate new ways of seeing people and to acknowledge that there is no one right way of looking at individuals. The aim of clinical work is to create a therapeutic environment that suites individual difference. 

One way of seeing a client's reality is through the medical model and the use of DSM IV. In this method client's realities are diagnosed based on the similarity between presenting symptoms and definitions of disorders, syndromes etc. Similar to other fields of medicine treatment follows a medically designated path and for many syndromes etc, the treatment includes pharmaceutical intervention. It is important to note that just like in other areas of medicine, the exact manner in which care is recommended is dependent on practitioner discretion. 

Many clients feel comfortable with this method. In fact, some of you have written that medical classifications and  pharmaceutical interventions have worked well for you or for your clients.  

However, as clinicians we must also take note of additional methods. As I stated in my first posting on this issue, for some clients it is not helpful to be classified as OCD, bipolar, etc etc. Yes, I am well aware that the medical perspective would clearly argue this point. Yet, it has been my experience that some clients do better when we "reframe" their pathology into something else and we do not classify their symptoms as syndromes, disorders or   disease.  Instead we see Ms X who states that she does this and that and it means this and that for her etc etc. We look at what the events that she is presenting mean for her and try to find an individually based therapeutic method. Sometimes this might mean that psychotherapy alone is enough or in other instances, psychotherapy might be used in conjunction with other interventions including, diet, natural aids or pharmaceutical products.

Psychotherapy has come a long way since Freud (but we should respect him for opening our eyes to the mind). There are so many different methods of helping people. As I wrote before, some methods look at origins of behaviors ( please note this does not mean that they focus only on  early childhood that is a misconception about this mode of therapy) and others might focus on strategies.  There are many, many other methods as well. 

Please, let us be respectful of  diversity in our views.  This is for the benefit of our clients. When a nursing mother presents with psychological issues let us remember that apparently similar issues might have different meaning for clients and that there are many solutions.

Keren Epstein-Gilboa MEd, BScN,RN, LCCE,IBCLC
(PhD student)
last long posting must get on with my thesis!

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