I yearn for my work, because it always helps me make sense of things.  For never was a horror experienced without an angel stepping in from the opposite direction to witness it with me.

Rilke – Letter to Marianne von Goldschmidt Rothschild December 5, 1914.

Next month’s issue of *Clinical Psychology Review* (February 2010,; vol.
30, #1) includes an article: “The efficacy of short-term psychodynamic
psychotherapy for depression: A meta-analysis.”

The authors are Driessen, Ellen; Cuijpers, Pim; de Maat, Saskia C. M.;
Abbass, Allan A.; de Jonghe, Frans; & Dekker, Jack J. M.

Here’s the abstract:

[begin abstract]

Objectives:

It remains largely unclear, firstly whether short-term psychodynamic
psychotherapy (STPP) is an effective treatment for depression, and
secondly, which study, participant, or intervention characteristics may
moderate treatment effects. The purpose of this study is to assess the
efficacy of STPP for depression and to identify treatment moderators.

Results:
(more…)

The University of Warwick issued a news release:  “Therapy 32 times more
cost effective at increasing happiness than money.”

PLEASE NOTE:  Contact info for the study’s author appears at the end of
the news release.

Here’s the University of Warwick’s statement:

Research by the University of Warwick and the University of Manchester
finds that psychological therapy could be 32 times more cost effective
at making you happy than simply obtaining more money.

The research has obvious implications for large compensation awards in
law courts but also has wider implications for general public health.

Chris Boyce of the University of Warwick and Alex Wood of the University
of Manchester compared large data sets where 1000s of people had
reported on their well-being. They then looked at how well-being changed
due to therapy compared to getting sudden increases in income, such as
through lottery wins or pay rises. They found that a 4 month course of
psychological therapy had a large effect on well-being. They then showed
that the increase in well-being from an ?800 course of therapy was so
large that it would take a pay rise of over ?25,000 to achieve an
equivalent increase in well-being. The research therefore demonstrates
that psychological therapy could be 32 times more cost effective at
making you happy than simply obtaining more money.

(more…)

The University of Montreal issued the following news release:

Canadian men reluctant to consult mental health services

University of Montreal study points to prejudice as No. 1 cause

Between 20 and 70 percent of Canadians affected by mental illness shun
medical treatment. Such avoidance of services provided by doctors and
psychologists is particularly acute among men, according to a recent
study published in the Journal of Behavioral Health Services & Research.

In Canada, less than 10 percent of the population utilizes mental health
services for problems ranging from depression to schizophrenia.

But this number isn’t representative of the real number of people
suffering from mental illness, according study author Aline Drapeau, a
researcher at the Université de Montréal’s Department of Psychiatry and
Centre de recherche Fernand-Seguin of the Louis-H. Lafontaine Hospital.

According to data from the Statistics Canada Canadian Community Health
Survey, women are 1.5 times more likely than men to turn to psychiatric
services, twice as likely to consult a psychologist and 2.5 times more
likely to turn to a general practitioner.

While these numbers might suggest that more women suffer from mental
illness, Drapeau disagrees.

“In comparable circumstances, women consult more often than men,” she says.

The discrepancy, says Drapeau, shows how men and women do not perceive
symptoms in the same way as programmed in their social anchorages.

“Social anchorages is an enculturation mechanism by which a person
learns his or her social roles,” says Drapeau.

“Men and women don’t always have the same cultural reference points
because socially acceptable attitudes and behaviors can vary for both sexes.”

For instance, parental obligations aren’t perceived equally in the
workplace. For women, it is perceived as positive to attend to maternal
duties.

For men, forgoing work to take care of the kids is perceived more negatively.

The same parallels exist in mental health. “If mental disease is seen in
a negative light in the workplace, a man will be more reluctant than a
woman to use the services available to treat their disease,” says Drapeau.

Other factors, such as tight finances or even type of employment, can
influence whether men use mental health services.

But the root of the problem, Drapeau stresses, is that men have greater
difficulty acknowledging and accepting their symptoms.

Ken Pope

Today’s *Vancouver Sun* includes an article: “Ancient Buddhism and
modern psychology; Both practices are focused on releasing followers
from suffering, and both aim for emotional health” by Douglas Todd.

Here are some excerpts:

[begin excerpts]

‘Everybody’s a Buddhist now.”  That’s what a Vancouver yoga studio owner
recently said, a wry twinkle in her eye.

She was noticing how many of her yoga students were joining western
nature lovers, spiritual seekers and global pacifists in describing
themselves as followers of the 2,500-year-old Asian tradition.

Most of them were finding their entrée into Buddhism through meditation
and the healing arts….

There are many natural links between Buddhism and psychology.

(more…)

Wiley-Blackwell issued the following news release:

CBT and BT: Some effect against chronic pain

Cognitive Behaviour Therapy (CBT) and Behaviour Therapy (BT) show some
effect in helping the disability associated with chronic pain, according
to a Cochrane Systematic Review. The researchers assessed the use of CBT
and BT on chronic pain, mood, and disability.

“For people with chronic pain, psychological therapies can reduce
depression and anxiety, disability, and in some cases pain, but guidance
is still required on the best type and duration of treatment,” says lead
researcher Christopher Eccleston, at the Centre for Pain Research at the
University of Bath.

Both CBT and BT try to manage pain by addressing the associated
psychological and practical processes. CBT involves the avoidance of
negative thoughts. BT helps patients to understand how they can change
their behaviour in order to reduce pain. Both approaches have been in
development for around 40 years and are sometimes recommended for
patients with long lasting, distressing pain that cannot be relieved by
conventional medicines.

In a systematic review, researchers considered the results of 40 trials
of CBT and BT, which included 4,781 patients in total. Patients
suffering from pain due to any cause, except headache, migraine, or
cancer, were included. Most studies were of CBT, which showed small
positive effects on pain, disability, and mood. There was less evidence
for BT, which the researchers say had no effect on disability or mood.

“Although there is overall promise for CBT in chronic pain, the term
covers a diverse range of treatment and assessment procedures. Right
now, we are not able to say which specific features of therapy may be
critical for improvement of a patient’s condition,” says Eccleston.

According to the researchers, simpler studies of CBT and BT that focus
on a purer form of treatment, rather than a variety of mixed methods,
would benefit the field.

A short youtube clip from a Toronto therapist explaining from her perspective what happens in therapy – the first session, and overall.  It’s a bit general, but gives you some of the flavour.  Bear in mind that, as she says, all sessions differ.

Here’s the link:

http://www.gotosee.co.uk/healtharticles/2009/03/guide-to-psychotherapy/

Press Release
April 02, 2007
Intensive Psychotherapy More Effective Than Brief Therapy for Treating Bipolar Depression
Patients taking medications to treat bipolar disorder are more likely to get well faster and stay well if they receive intensive psychotherapy, according to results from the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD), funded by the National Institutes of Health’s (NIH) National Institute of Mental Health (NIMH). The results are published in the April 2007 issue of the Archives of General Psychiatry.

Bipolar disorder is a debilitating illness marked by severe mood swings between depression and mania that affects 2.6 percent of Americans in any given year. “We know that medication is an important component in the treatment of bipolar illness. These new results suggest that adding specific, targeted psychotherapy to medication may help give patients a better shot at lasting recovery,” said NIH Director Dr. Elias A. Zerhouni.

“STEP-BD is helping us identify the best tools-both medications and psychosocial treatments-that patients and their clinicians can use to battle the symptoms of this illness,” said NIMH Director Thomas R. Insel, M.D.

Psychotherapy is routinely employed as a means to treat bipolar illness in conjunction with medication, but the extent to which psychotherapy is effective has been unclear. In addition, most psychotherapeutic studies have been limited to a single site and compared only one type of treatment to routine care. Thus, in addition to examining the role of medication, STEP-BD set out to compare several types of psychotherapy and pinpoint the most effective treatments and treatment combinations.

With 293 participants, David Miklowitz, Ph.D., of the University of Colorado and colleagues set out to test the effectiveness of three types of standardized, intensive, nine-month-long psychotherapy compared to a control group that received a three-session, psychoeducational program called collaborative care. The intensive therapies were

* family-focused therapy, which required the participation and input of patients’ family members and focused on enhancing family coping, communication and problem-solving;
* cognitive behavioral therapy, which focused on helping the patient understand distortions in thinking and activity, and learn new ways of coping with the illness; and
* interpersonal and social rhythm therapy, which focused on helping the patient stabilize his or her daily routines and sleep/wake cycles, and solve key relationship problems.

All participants were already taking medication for their bipolar disorder, and most were also enrolled in a STEP-BD medication study reported in the New England Journal of Medicine on March 28, 2007. The researchers compared patients’ time to recovery and their stability over one year.

Over the course of the year, 64 percent of those in the intensive psychotherapy groups had become well, compared with 52 percent of those in collaborative care therapy. Patients in intensive psychotherapy also became well an average of 110 days faster than those in collaborative care. In addition, patients who received intensive psychotherapy were one and a half times more likely to be clinically well during any month out of the study year than those who received collaborative care. Discontinuation rates among the groups were similar-36 percent of those in the intensive programs discontinued and 31 percent of those in collaborative care discontinued. None of the three intensive psychotherapies appeared to be significantly more effective than the others, although rates of recovery were higher among those in family-focused therapy compared to the other groups.

“Intensive psychotherapy, when used as an adjunctive treatment to medication, can significantly enhance a person’s chances for recovering from depression and staying healthy over the long term,” said Dr. Miklowitz. “It should be considered a vital part of the effort to treat bipolar illness.”

Reference

Miklowitz D. et al. Psychosocial Treatments for Bipolar Depression. Archives of General Psychiatry. Apr 2007; 164.

[Press release from US National Institute of Health  http://www.nih.gov/%5D

When do you stop going to therapy?  An x-ray can tell you that a broken bone is mended and that you can walk on it. But you aren’t a bone.  Here are some ideas to help you decide when you are done with therapy.

All of this assumes that you are working with a therapist who is a good fit for you. You feel you can trust them, you are in agreement on how to address your issues, and on what you are basically doing there. If you are there to understand your marriage and your therapist thinks you are there to feel less anxious, you have a mismatch and need to sort this out right away.  If you want to learn better coping skills and your therapist thinks you are there to understand your dreams… get on the same page.  If you can’t, find someone else.

Ideally you will leave therapy when you’ve accomplished the goals you’ve set for yourself.  When you started, you should have had some sense how you wanted things (you)  to be different when therapy is complete.   You can and should check in from time to time with your therapist about how you are doing and where therapy is going.  I like it when my clients do this.  I like looking for signs of progress, and sharing our insights. You should see signs of progress within one to three months. It might take longer to resolve, but you should not be waiting years to see something happen.

Some issues resolve pretty quickly, others can take a long time. Part of this depends on what level of work you are doing.  If  you are trying to find strategies to deal with  a specific life problem or make a decision, you probably won’t need to go for long.  Changing a specific behaviour might not take that long either,  depending on what it is. If  you are trying to change a part of your personality, this can take quite a while – minimum six months, and it could be years.  Trauma work generally takes a while, and the earlier it began and the longer it lasted, the more time it will usually take. Generally, short-term issues lead to short-term therapy. Long term issues, especially those that began in childhood, generally mean longer therapy to be resolved.

Other clues that you might be done are:

  • When you have made or resolved the life transition that brought you to therapy and you are getting on with life.
  • When you feel that you know how to deal with your feelings and relationships, and the problems life throws at you.
  • When you feel confident in who you are, what you feel, and what you want and you can stand up for these.
  • When you are able to make free, smart, and responsible choices for  yourself out of love and not fear.
  • When you are able to love as freely as you would like, and let others love you.
  • When you have good boundaries with others. You can let them in… or not. You can go along with them… or not.
  • When you are able to feel your feelings and you don’t take your feelings out on others.
  • When you are not in the power of an addiction.
  • When you are not haunted by past events any more.
  • When you have some sense what you want from life and are able to go for your dreams.
  • When you are able to work effectively, but also to have fun, play and relax.
  • When you feel that you now thoroughly know yourself.  You understand the sources of your happiness and unhappiness and know what to do about these.
  • When the problem that brought you to therapy is solved and you have worked through the other issues that came up along the way.

It’s usually not a good idea to stop just because you start to touch uncomfortably strong feelings or issues. Or you get scared of your feelings or impulses that are coming up.   It can be tempting at this point to think that therapy is not working or just making you worse. Strong feelings, including those about the therapy, are actually a great reason to continue. You are now getting ready to do some of the real work, discovery and healing.  The deeper problems are now within reach and are available to be explored.

However, if you are not learning any more, this is a clue that you  could either end therapy or else increase the heat. If you are just chatting session after session, there is something missing. Maybe you are not going deep enough, or maybe you are done and don’t realize it.  Discuss this with therapist. It’s not criticism. Even if it were, the therapist should be able to take it.

I appreciate it when I know we are near the end, and the client doesn’t just stop coming without telling me.  When I know we have just a session or two to go, I have a different focus, and use the sessions accordingly.  There might be a specific piece of work I want to suggest or a skill I’d still like to teach, and if I don’t have warning, this gets lost. An end date might be next week, it might be in 5 months. Some of my long-term clients like to taper off – checking in less often and spreading out the appointments.

If you feel that you’ve accomplished what you wanted to, but your therapist hasn’t said anything, it’s up to you to tell him or her that you are ready to leave therapy.  Then you can discuss it. The therapist may agree and be really pleased for you.  Remember that the therapist’s job is to make him or herself unncessary. Or he or she might be able to point out a possible next step that you overlooked. Then you discuss whether you want to do that piece of work or not.

If you are a bit scared about leaving therapy, remember that you can always go back if you need to.  And it can be nice and affirming to check in some time later, even if it is no longer a necessity.  Because you now know it is not a necessity!

Brian Grady, Ph.D. Registered Psychologist

23 Marchh 2009

I recently came across this article by Dr. Kevin Grold.  Here are some extracts.

————————–

A good therapist for one person is not necessarily the right therapist for another person. You have to find a good match for your personality.

[snip]

THE PROCESS

First, and most importantly, start by finding three therapists to interview for the position of “your therapist.” [snip]

If you have a close friend who … is seeing a therapist who is being helpful, what better recommendation could you receive for the beginning of your search? I would say, “Start with THAT therapist.” [snip]

Let’s say you decide to ask your family doctor for a recommendation. Your doctor probably has one licensed therapist in the office building who he or she uses for cross-referrals.[snip]

Another way to develop your list of three interviewees is to call a referral service.
[snip]

MAKING THE CALL

Next, call your three therapists and say, “I am considering becoming a new client of yours, is there a time we could discuss this for five minutes?” The therapist may be busy at the time you call but this allows him or her to set up another time to have a short phone call with you. Do not expect a full counseling session on the phone, but do expect to be able to say, “Here are the issues I have been facing–do you have any experience in this area?–How would you approach such issues?–What would you consider your therapeutic approach to be?” These questions will help you prioritize your list of three therapists from most to least favorite. If a therapist is not willing to take 5 minutes of time to talk with you over the phone, then you have an easy decision to cross that name off the list.

Next, make an appointment with the therapist with whom you felt most comfortable on the phone. If after the first session, you feel you may have not chosen wisely, do not continue.  Instead, go to the second therapist on your list. Remember that you are making a choice for a life-long companion and guide. Do not take this decision lightly.

the full text is avaiable online at
http://www.1-800-therapist.com/how_not_to_choose_a_therapist.htm