Next month’s issue of *Clinical Psychology Review (Feb, 2010; vol. 30,
#1) includes an article: “Psychotherapy for chronic major depression and
dysthymia: A meta-analysis.”

The authors are Cuijpers, Pim; van Straten, Annemieke; Schuurmans,
Josien; van Oppen, Patricia; Hollon, Steven D.; & Andersson, Gerhard.

Here’s the abstract:

[begin abstract]

Although several studies have examined the effects of psychotherapy on
chronic depression and dysthymia, no meta-analysis has been conducted to
integrate results of these studies.

We conducted a meta-analysis of 16 randomized trials examining the
effects of psychotherapy on chronic depression and dysthymia.

We found that psychotherapy had a small but significant effect (d =0.23)
on depression when compared to control groups. Psychotherapy was
significantly less effective than pharmacotherapy in direct comparisons
(d =-0.31), especially SSRIs, but that this finding was wholly
attributable to dysthymic patients (the studies examining dysthymia
patients were the same studies that examined SSRIs).

Combined treatment was more effective than pharmacotherapy alone (d
=0.23) but even more so with respect to psychotherapy alone (d =0.45),
although again this difference may have reflected the greater proportion
of dysthymic samples in the latter.

No significant differences were found in drop-out rates between
psychotherapy and the other conditions.

We found indications that at least 18 treatment sessions are needed to
realize optimal effects of psychotherapy.

We conclude that psychotherapy is effective in the treatment of chronic
depression and dysthymia but probably not as effective as
pharmacotherapy (particularly the SSRIs).

[end abstract]

The author note provides the following contact info: <p.cuijpers@psy.vu.nl>.

Courtesy of Ken Pope

We are all so different…but so similar in some of our patterns. Especially the limiting  or negative ones.

Psychiatric personality diagnosis tries to provide some order, but sometimes alienates people. Who wants to have a “disorder”?  Must be something deeply wrong with me. But it’s easy to  think of our personality ‘issues’ (in olden days: “neuroses”) with much more compassion and understanding.

As young people growing up in the world of our family, our schools, neighbourhoods, with all their challenges, we face certain common, human problems. Like: how will I be accepted? How can I get recognition and love? How can I get attention for what I need? How can I belong? How can I assert my independence? What do I have to do to feel safe? Where can I express myself?

Depending on the world we are in, along with the basic temperament and body we’re born with, it can be pretty tough, but not solving these problems is not an option. So we do the best we can with our little bodies and developing minds. And it is not surprising that we come up with some similar solutions to these similar problems. We try out lots of things. We’ll be good –  OK, that didn’t work, we’ll be bad. Hmm, that didn’t work, we’ll be cute. No? Beautiful? How about smart?  Stoned? Funny? Needy? Withdrawn? Strong? Tough? Aha! Recognition. Success.  Partial solution to an otherwise insolvable problem. Now I can get the love/recognition/safety/freedom etc I need.

We try the solution out over and over. Eventually, we become it, we live it. It’s gone beyond being a strategy, now it’s a way of life, of thinking, perceiving things, of feeling. Who we are. We’ve figured out to go down a path others have followed too. So it starts to look like, even though we are unique, we share personality traits in common with others. It’s not too surprising that we came up with similar solutions to similar kinds of problems.

As we grow up, we may gradually, dimly realize that we pay a price for the early solutions. As a Nobel laureate commented (I forget the source), “what I really wanted was love, but I accepted a Nobel prize”. Work…worked. But it was only a partial solution. Or, in the case of addiction, Dr. Gabor Mate suggests addicts try to fill “a God-shaped hole in the heart of every man which cannot be filled by any created thing” (Blaise Pascal) with a substance. Leaving it unfilled is not an option, even at a huge price.

Our partial solutions were absolutely the best we could come up with at the time to solve an otherwise unsolvable set of problems.  Some would call this pathology, neurosis, personality disorder, “issues”. I prefer to see the glass half full. Let’s recognize what a challenge it is to grow up and be someone, and appreciate the struggles, and acknowledge the efforts made along the way to solve these crucial and otherwise unsolvable  problems.  Then we can gently and therapeutically begin to find more creative, fulfilling (and adult) alternatives.

Brian Grady, Ph.D. R.Psych

How to Figure Out When Therapy Is Over
By RICHARD A. FRIEDMAN, M.D.
Published: October 30, 2007 New York Times

If you think it’s hard to end a relationship with a lover or spouse, try breaking up with your psychotherapist.

A writer friend of mine recently tried and found it surprisingly difficult. Several months after landing a book contract, she realized she was in trouble.

“I was completely paralyzed and couldn’t write,” she said, as I recall. “I had to do something right away, so I decided to get myself into psychotherapy.”

(more…)

The Toronto *Globe & Mail* includes an article: “Meditating through
mental illness” by Anne McIlroy. 15 Aug 08.

Here are some excerpts:

[begin excerpts]

The patients are sitting still, their eyes closed, meditating, on the
floor of a group therapy room at the Centre for Addiction and Mental
Health in Toronto.

It is the fifth week of an eight-week training course in mindfulness
meditation for people recovering from depression.

Their goal is to treat any troubling thoughts or emotions with the same
detachment with which they monitor the breath flowing in and out of
their bodies.

Mindfulness-based psychotherapy is growing rapidly in popularity, and
these patients are part of a $2.5-million clinical trial to assess
whether it can prevent relapses as effectively as antidepressant medications.
(more…)

Prozac Nation No More?

In a new book, psychiatrist James Gordon explains why he believes there’s a more effective and drug-free way to treat depression and anxiety.
Anne Underwood
Newsweek Web Exclusive
Updated: 8:56 AM ET Jul 8, 2008

Do we really need Prozac? James Gordon, founder of the Center for Mind-Body Medicine in Washington, D.C., says there’s a better way to treat depression—through diet, exercise and meditation. Roll your eyes all you like. He’s used the approach for 35 years with a wide range of patients, from runaway children and middle-class adults in Washington, D.C., to victims of war in Bosnia, Kosovo, Israel and the Gaza Strip. This week, Gordon is heading to flood-stricken Iowa to see if he can be of assistance there. About 10 percent of American women and 4 percent of men now take antidepressants (according to a 2004 CDC report). Gordon’s new book, “Unstuck: Your Guide to the Seven-Stage Journey Out of Depression,” outlines a treatment program he believes can be an alternative to medication. NEWSWEEK’s Anne Underwood spoke to Gordon about his recommendations and how he’s implemented them around the world. Excerpts:
(more…)

5/27/2008 *New York Times* includes an article: “Lotus Therapy” by
Benedict Carey.

Here’s how the article begins:

The patient sat with his eyes closed, submerged in the rhythm of his own
breathing, and after a while noticed that he was thinking about his
troubled relationship with his father.

“I was able to be there, present for the pain,” he said, when the
meditation session ended. “To just let it be what it was, without
thinking it through.”

The therapist nodded.

“Acceptance is what it was,” he continued. “Just letting it be. Not
trying to change anything.”

(more…)

*Science Daily* released an article: “Patients Do Better With
Psychotherapist Who Practice Zen Meditation, Study Suggests.”

Here’s the article:

An investigation by German researchers headed by Professor Nickel
indicates the practicing Zen meditation by psychotherapists matters. All
therapists direct their attention in some manner during psychotherapy. A
special form of directing attention, ‘mindfulness’, is recommended.

(more…)

*Clinical Psychology Review* (June, 2008, vol. 28, #5) includes an article: “The relative efficacy of bona fide psychotherapies for treating post-traumatic stress disorder: A meta- analysis of direct comparisons.” The article is by Steven Benish, Zac Imel, & Bruce Wampold.

Here’s the abstract: “Psychotherapy has been found to be an effective treatment of post-traumatic stress disorder (PTSD), but meta-analyses have yielded inconsistent results on relative efficacy of psychotherapies in the treatment of PTSD. The present meta-analysis controlled for potential confounds in previous PTSD meta-analyses by including only bona fide psychotherapies, avoiding categorization of psychotherapy treatments, and using direct comparison studies only. The primary analysis revealed that effect sizes were homogenously distributed around zero for measures of PTSD symptomology, and for all measures of psychological functioning, indicating that there were no differences between psychotherapies. Additionally, the upper bound of the true effect size between PTSD psychotherapies was quite small. The results suggest that despite strong evidence of psychotherapy efficaciousness vis-à-vis no treatment or common factor controls, bona fide psychotherapies produce equivalent benefits for patients with PTSD.”

New York Times (21 Aug 2007) includes an article: “To Reap
Psychotherapy’s Benefits, Get a Good Fit” by Richard A. Friedman, M.D.

The author note states: “Richard A. Friedman is a professor of
psychiatry at Weill Cornell Medical College.”

Here’s the article:

Americans seem to like psychotherapy. Whether it’s for the mundane
conflicts of everyday life or life-threatening illnesses like major
depression, psychotherapy is widely viewed as a healthy, if not
harmless, pursuit.

Yet unlike most other medical treatments, psychotherapy can take
considerable time. An infection can be cured in days, but remission of
severe depression or anxiety disorder usually takes weeks or months, and
a personality disorder typically requires years of intensive psychotherapy.

So if the outcome may be months or years away, how can a person tell
whether his psychotherapy is any good? (more…)

  • A climate of mutual safety and respect is paramount
  • We have within us the seeds of the solutions we need. In therapy we discover these, learn to trust them, and then have the courage to live them, each in our own way.
  • Positive change can occur more easily than you might expect. We may believe we are more stuck than we are.
  • Understanding and practice are both essential. Insight needs to be applied. Action needs awareness. We learn to live what we know, and to know what we are living.
  • We have more inner resources than we know. Our own truth is one of these resources. My job is to remind you of this.
  • Mind and body are intimately connected. Change in one can lead to change in the other.
  • Small changes add up. We need to persist with these.
  • Sensible risks are essential. Learning to act from confidence and love, rather than fear, makes this possible.
  • Different people and problems require different therapeutic approaches.
  • There is more to us than we know. Maybe more than we can know.
  • Some problems respond well to a head-on approach. Others need us to respect their mystery and depth. Learning to know the difference saves us much frustration.
  • You do some of this in sessions and some in your life.
  • All of the above works when we are being mindful. Mindfulness means non-judgmental, interested awareness of our present experience.
  • In therapy, we learn to pay close attention to how we feel, think, and respond to the world and other people. Doing this helps us to see where our resources and strengths are, and where we are living out old belief patterns that no longer serve us.

My goal: To understand and accept your truth and choices (though not excuses), help you to discover and know what your life requires of you, and encourage you at every step to know and to act from what is most true for you. I have no agenda for how you should live your life. That is your choice and responsibility. But I do wish my clients to live with awareness of themselves, with their needs, feelings, choices, and history, and to be true to themselves. The rest flows from there. I hope people will choose to become more truly themselves, maturing and becoming free to choose well how they live and react.

If therapy has risks, it is that we may experience what we feel, who we are, and the impact of previous events strongly at times. We may be called to try out different behaviours, have new experiences, and to relate differently to others. It may all take time, patience, and persistence. And in therapy, as in life, there are no guarantees. You can and should talk about how therapy is going with your therapist. Everyone comes to true therapy as a volunteer, which means that you conclude when you wish to and you will never be compelled to go against your true wishes.

Brian Grady, Ph.D