One Size Does Not Fit All

When considering treatments (both psychological and medical), we must remember that people vary, and so the treatment of choice (in general) may not be the treatment of choice (for you). While this is less often the case in the medical arena, where bodies are more consistent (as compared to minds and personalities), there are variations even between people in terms of how one’s body may reject or react to a certain treatment. (Anyone who watches the television show “House” has a front-row seat to this exception proves the rule type of issue.)

I mention this issue of “fit” when it comes to treatments after reading a recent study which examined the benefits of expressive writing (a generally well-proven treatment) among military veterans. Adler and colleagues found that, despite the benefits of this writing style for civilians, among a veteran population it actually hurt more than helped. The take away point from this is that: a) science and research are important to confirm our ideas, but also that b) just because a treatment works with one group of people doesn’t mean it will work for all people.

Similarly, a recent Newsweek article blasts psychologists for not adhering to “proven” treatments, instead favoring personal preference and opinion as guidelines for treatment. Now, you should certainly question your doctor if s/he asks you to engage in any treatment you feel is too fringe or odd. That being said, what the Newsweek article fails to address is the theme of this post – that there is an art that is involved in the application of science, and psychology (and pain management) falls into that category more than many other medical pursuits. There is a “fit” that is necessary for treatments to work, and despite the mounds of evidence that certain treatments should work, that doesn’t mean they always will work. There are always exceptions to the rule – often in psychology, to make for a good study, certain patients are excluded because they don’t fit certain criteria. Well, you may not fit the criteria either, so the treatment may have been proven to work on most people, but the people most like you might not have been included in the study. An important point to remember as a patient is that this cuts both ways – you may not be receiving the treatment that helped your friend because your doctor knows that you and your friend have different issues/backgrounds, and you may not fit the patient profile that the treatment was proven to work on.

Now, this doesn’t mean that some research supporting your doctor’s choices isn’t warranted – many good clinicians collect their own internal data, monitor trends, and keep up on the latest research to be sure that the art doesn’t stray too far from the science. With this post I am not promoting bizarre treatments for the sake of being different – clinicians should almost always start with the standard treatment and move to other ideas only if the standard treatment fails. However, there is a finesse that cannot be learned in school, books, or research articles. In psychology especially, we as a profession are easy targets for comedians, with people saying how “anyone can do what you do.” And while it may look that way, a good clinician (though not all clinicians), will be considering the science, the person, the artistic application of the science, and the timing all before saying “tell me how that makes you feel.”

I have found myself in some weeks proposing the same solutions and coping mechanisms to multiple patients – and I admit that as a sign of failure. Even if all their symptoms and issues matched up, they are different people who should receive tailored treatments, not cookie cutter application of the same speech from the same psychologist. And pain patients know this better than most – you compare with fellow patients and determine that Dr X always gives her patients Vicodin first, or that Dr Y tells all his patients that better stress management is the key to coping with pain. This doesn’t mean Doctor X or Y are wrong – but it makes you wonder if you are getting the right treatment for you.

So question your doctors, ask what else then can do for you, tell them when treatments have side effects or feel like they aren’t working. Don’t play doctor or quote the Internet as your legitimate source – trust that medical and graduate school have taught us something – but remember you are the expert on you, and we need to fit the treatment to the patient, not the other way around.

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