What We’ve Said

What we’ve said about Treatment goals

7 points from 6 episodes, newest first

In short

Aim for long-term function and a life the patient wants, not remission forever or the symptoms of the day. Match the goal to what is actually driving the problem, and in bipolar disorder make fewer ups and downs the target.

Setting the goal

  1. The primary goal is to put the patient on a trajectory toward long-term executive function improvement and a life worth living, in the way they want it. Look for functional, long-term goals, not short-term ones.

    “the primary goal is to put the patient on some trajectory for long term executive function improvement and a life worth living in the manner that they want it. OK, look for the functional goals. The long-term goals, not the short-term goals”
    32:35Treating Borderline Personality Effectively aka How To Be A Good Psychiatrist Through GPMMay 2025

  2. In medication management we are not trying to get anyone into remission forever, which is unrealistic. The aim is a lifestyle and a process that moves the patient closer to the things they want and further from the things they do not.

    “When I do medication management, I'm not trying to get you into remission forever. It's unrealistic. Okay. I want you to engage in a lifestyle and a process that gets you closer to the things that you want and further away from the things that you don't”
    42:49Is Psychoanalysis Still Relevant in Modern Psychiatry?Oct 2025

  3. In bipolar disorder, make the cycling the treatment goal, not particular symptoms. Tell every patient: we are focusing on fewer ups and downs, not on how you are feeling on a particular day.

    “focusing on the cycling as the treatment goal and not the particular symptoms. I hope that's the one thing you take away. And I say this with every patient with bipolar, we're focusing on less ups and downs, not on a particular how you're feeling that day”
    14:48How to Diagnose Bipolar Disorder with Dr. Phelps: Hypomania, Mixed States & the Clues DSM MissesSep 2026

Matching the goal to the problem

  1. Treat the cause. If poor concentration comes from fear of losing a relationship or fights that keep happening in it, the way to treat it is not going to be Zoloft.

    “if your problems with concentration are happening because of a stressor of fear over losing an unfortunate relationship or all these fights that keep happening over and over in your relationship, then the method of successfully treating that is not going to be Zoloft”
    27:45Treating Borderline Personality Effectively aka How To Be A Good Psychiatrist Through GPMMay 2025

  2. Stopping behaviors is not the treatment approach. We default to it because we conceptualize only the pathological aspects of personality.

    “Behavior stopping is not the treatment approach. We're so used to that because we're trying to conceptualize only pathological aspects of personality”
    5:18Healthy Personality Traits, Trauma vs. Personality, and Why Trauma Doesn’t Explain It AllOct 2024

  3. In PTSD the goals include maintaining safety, reducing distress from intrusive re-experiencing (nightmares, flashbacks, unwanted thoughts) and reducing hyperarousal.

    “maintain safety is a huge one reducing symptoms of distress related to intrusive re-experiencing talking about nightmares flashbacks unwanted thoughts all that good stuff reducing hyper arousal”
    3:10PTSD Medications: Integrating Pharmacotherapy, Therapy, and the Treatment Frame | Episode 22Apr 2025

When a goal gets in the way

  1. Mindfulness is not an outcome-focused practice. Practicing it with a particular outcome in mind subverts it: people who do it to get better may or may not get better, but they will certainly downgrade the experience and the benefit.

    “it's not an outcomes focused Practice. If you try to practice mindfulness with a particular outcome in mind, it will subvert the efficacy of the practice itself”
    19:16Mindfulness in Psychiatry: How to Teach It as a Clinical Treatment SkillMay 2026
    Also said in 2 more episodes
    “with mindfulness, no one who does it to get better will ever get better. Because what they're getting better from is the someone who wants to get better”
    21:09Mindfulness in Psychiatry: How to Teach It as a Clinical Treatment SkillMay 2026
    “I don't know if they won't get better, but they will certainly downgrade their experience and the benefit”
    21:21Mindfulness in Psychiatry: How to Teach It as a Clinical Treatment SkillMay 2026

From these episodes

Every point above is something said on the Psychofarm podcast, with the words as spoken and a link to the moment in the episode. It is education, not medical advice, and an episode reflects what we thought when we recorded it.

Educational content only. Everything here is what was said on the Psychofarm podcast, for clinicians. It is not medical advice and not a substitute for clinical judgment, current labeling or guidelines. An episode reflects what we thought when we recorded it, so check anything before you rely on it.