David Dybdal, MD, PhD
Psychotherapy & the Medical Model
Through my professional and personal experience, I have come to understand that mental and emotional suffering, perhaps even more so than physical injury, can be the cause of a most unbearable pain.
Traditionally, patterns of mental and emotional pain have been associated with, and are sometimes thought to be caused by various psychiatric "diseases" such as major depressive disorder or generalized anxiety disorder.
In fact, such labels have, for the most part, simply been made up by the medical, pharmaceutical, insurance and other industries.
These labels are applied when a pattern of symptoms are rather subjectively judged as being present, and they do not actually indicate anything much more than a common categorization and belief system.
I believe that the causes of such mental and emotional symptoms are just as likely to be due to a very broken, fearful, and traumatic environment that impinges upon individuals who have a certain susceptibility, vulnerability, and sensitivity.
I do not believe that any person that has such symptoms should necessarily be labeled as sick, or diseased. In other words , the cause of symptoms may not be contained within the individual but rather precipitated by a traumatizing external environment.
Health insurances uniformly require the usage of a disease-based model, including in the realm of mental health. The mandated standard that insurance companies use is referred to as "medical necessity." By insurance company standards, treatment is warranted if, and only if, a patient has mental "disease," and the goals of such treatment are to reduce the severity of symptoms. This tends to reinforce the idea that patients are "broken" and must be "fixed."
Furthermore, a patient may move from "severe depression" to being less depressed, or even not depressed; but, by insurance standards, they may not be assisted to go beyond absence of depression to develop a sense of meaning, fulfillment, or joy in their lives.
For these reasons, I do not enter into contracts with insurances (i.e., I am not "in-network"). Instead, I offer a concierge-style, private practice in which I provide weekly psychotherapy appointments with or without the addition of medications. This allows time and opportunity to explore the complex interaction between biological, psychological, social and spiritual facets of a person’s condition.
My focus, therefore, is not to fix broken people, but to help human beings who are sensitive, intelligent and intuitive, to become more aware of:
1. traumatizing elements of our communal environment,
2. patterns of reaction to such elements,
3. how to develop more effective skills so as to navigate the external traumatic environment in a more skillful manner.
Over time, and with continued practice, healing can occur, allowing for the experience of more freedom, joy, and satisfaction, even in the continued context of a potentially traumatizing external reality.
If you are interested in further discussing these issues, and embarking upon such a journey, please be in touch!
All the Best,