All the rivers of psychodynamic therapy combine

I hold to the belief of all therapy having one common theme to it. There is one expectation from therapy and that is too work. And sometimes not to work but do the least bit of damage. To explain all the intricate manifestation of human behavior, all theories come fairly close to each other. Yes they differ also on some key elements but then again if a therapist cannot practice being all inclusive, he or she runs the danger of trying to see everything in the world as all squares or as all circles.
The discussion of Beck about modes of cognition which exist in our minds and how they become activated through cognitive reactivity brings back some memories of archetypes that Jung talks about.
My psychotherapy supervisor, who i just started with believes in thinking in psycho dynamic terms but making plans keeping in mind behavioral or interpersonal principles. I found his approach as somewhat unique. He believes that initially the problem needs to clarified. One should be clear whether one is dealing with problem of libidinal drives, problem of function of the ego (like reality testing, impulse control etc), problem with how the person perceives the world around it or how the person recognizes itself. By this he is combining all the schools of psycho dynamics and giving each of them a place to help formulate each case.
The four schools broadly being drive theory, self psychology, object relations and ego psychology.

I think every good therapist tries to unite all these things in the mind and clinical practice. It is informative trying to see what every one's picture of unity looks like.

My previous psychotherapy supervisor who is a man held in awe by many including myself, was a minimalist. He was the king of brevity. Actually still is. He saw all therapy and condensed it into the very basic rudimentary dynamic. On those basic framework of dynamics he would plan the clinical dance to take some very interesting forms.

Pakistan and ADHD

I was trying to research ADHD in Pakistan today and came across this article from J Pak Med Assoc. 2003 Sep;53(9):441-3

Qureshi A, Thaver D.Aga Khan University Hospital, Karachi.

Ok so ADHD exists in Pakistan. Now what is the treatment for it. Primarily would be the use of analeptics. If one class of analeptics is not effective the medication can be switched to the other class and ~90% children respond. One class being the Methylphenidate products like Ritalin and the long acting methylphenidate products and methylated compounds of methylphenidate. The other class is the amphetamine salts like dextroamphetamine and the mixture of the two enantiomers of the dextroamphetamine (Adderall, Vyvanse, Dexedrine). In Pakistan only the MPH compounds are available.

I found Ritalin at an online pharmacy. 10 mg tablets. The price is Rs 4.7 for 10mg. It is certainly not steep. A 40kg child would be taking roughly 1mg/kg/dose as the high end would end up spending ~Rs 18. If this dose is taken two to three times a day the cost increases up to 18x3=54. If this is not given on days off from school, the child will take it ~20 days. So Rs 1080 for an entire month.

Now the question is what is the other option besides Ritalin. Nothing. I have not been able to find Amphetamine salts. Second line medications like Alpha 2 agonists (Guanfacine and Clonidine) which are also used as blood pressure medications are also not available.

Bupropion is available. This also a second to third line agent. 75 mg tablet costs Rs 10. It is usually needed in doses of 150mg-300mg and everyday medication will make it a cost of anywhere from Rs 600-Rs 1200 per month.

Atomoxetine is not available. That would also be a second to third line agent. Especially useful in children who cannot withstand analeptics.

Then there is the tricyclics, which are available but that would be third line agents and not the best medications for a hyperactive child. Side effect profile unfavorable.