The Future of Psychotherapy for Mentally Ill Children and Adolescents by John S. March is not the kind of article I usually read — or so I thought until our psychiatric nurse practitioner here at Kartini Clinic, Janiece, put it on my desk (Janiece Desocio PMHNP, PhD, and a distance professor at the University of Rochester). Now all I can say is “Wow!”
It’s a dense article with big concepts like “translational developmental neuroscience” and “epigenetic amelioration”, but what Dr. March has to say is well worth quoting.
He begins by saying that “the great majority of mentally ill adults were first mentally ill as children.” Doesn’t that sound like a chronic illness to you? (See my previous blog on this subject) He goes on to say ” …mental illness can be referenced directly to the developing central nervous system (CNS) and its interactions with the environment.” He feels that the psychotherapy of the future will “focus less on personal narratives and more on the developing brain” as “mental illnesses are best thought of as neuro-developmental disorders.”
In other words: it’s the brain, friends, it’s the brain in complex interaction with its environment. And this complex interaction began during the earliest stages of brain development, when things that go wrong can have long-term consequences for adult life.
The good news is that “remedial instruction” is possible. In other words, even the adult brain can learn and in so learning reverse (bio-chemically!) things that went awry in earlier brain development. Medication may be necessary, but medications alone (at least those available to us currently) will not work, which is in keeping with everyone’s clinical experience as well.
Dr. Marsh feels that CBT (cognitive behavioral therapy) has left all other forms of psychotherapy behind in the dust. In fact this addresses what has become one of my pet peeves: the proliferation of psychiatric practices (either by psychiatrists or psychiatric nurse practitioners) which engage in “medication management” for thirty minutes at a time, tweak the medications according to presence/absence of side-effects, charge a lot of money and do no therapy of any kind.
Dr. March concludes that psychiatry will move to a “unified cognitive-behavioral intervention model that is housed within the neurosciences medicine,” that is to say, move to a fusion of the current medical and psychotherapy models, but with a proper focus on and understanding of the various functions (and malfunctions) of the organ responsible for all behavior, namely the brain. He further hopes that this new understanding will lead to earlier recognition of “predictable prodromes” (i.e. symptoms that may not quite reach diagnosable thresholds yet) and the development of individualized interventions based on a person’s genetic predisposition and medical/social/trauma history.
Want to read this astonishing article for yourself? It is in the Journal of Child Psychology and Psychiatry 50:1-2 (2009) pp 170-179 and well worth the effort.
