Psychotherapy: A Series of Thoughts

Many books have been written in hope of defining psychotherapy. Here’s a very short attempt (has appeared as part 1, part 2, on the ‘psychotherapy?’ page):

Psychotherapy is a conversation between two people — where one person predominantly talks and the other predominantly listens. The goal of the conversation that develops is to foster insight into the nature of the person doing most of the talking, as well as insight into that person’s problems. But insight is not enough. The important work is somehow getting that insight to stick. To incorporate it into that person’s life in meaningful ways that in turn helps that person better adjust to her or his life.

Even such a simple definition leaves so much that is important out, and there are so many questions it raises, and statements that beg qualification.

Not a blame game.
Psychotherapy is not about complaining endlessly about past injuries. It is not about painting family members as the cause of all our problems. It can be about understanding one’s perceptions of past and present events and how those perceptions color our views of our daily life. Some misunderstand psychotherapy as playing a blame game, not accepting responsibility. Quite the reverse, psychotherapy encourages us to examine and challenge our own perceptions (which may or may not resemble historical truth) of the past. It is important to examine perceptions, because it is our perceptions which shape how we perceive our current world, and inform our decision making and actions.

Making meaning.
Human beings are meaning-making creatures. Faced with confusion, we will attempt to find meaning, even where there is none. Psychotherapy is about uncovering and addressing those meanings. Meanings may generated within one’s self, within one’s family, within one’s community, within one’s culture. Those meanings that may even be obscure to ourselves. A good therapist will gently challenge us to examine inconsistencies in our perceptions and beliefs about ourselves and our interactions with others — and to examine what they might mean. Psychotherapy does not generally come upon “Eureka, that’s it!” sorts of answers, although such insights may suggest further avenues of inquiry. It is a very process-focused endeavor that studies our questions about ourselves in a sustained, methodical, and patient manner.

Recognizing patterns.
Before we can begin to understand our patterns, we have to become aware of them. Part of what psychotherapy does is help to make people more aware of patterns and behaviors that they themselves might not have noticed. It is a process of teasing out the many possible sources that contribute to those behaviors. Many patients express a sense of relief when they are able to bring new meaning to a past situation they had viewed simply from one perspective.

When solutions become problems.
Often the problems we bring to therapy represent our best solutions to our problems — but they are solutions that have stopped working, and in some cases have become new problems. Psychotherapy is an intervention to help us not repeat endlessly the same unproductive solutions.

An authentic emotional connection.
Purely intellectual understanding is very limited. There has to be an authentic emotional connection in connection to our understanding of past events in order to effect meaningful change. A therapist will help you to hone in on, rather than gloss over aspects of your life which seem to be potentially loaded with emotional meaning. A good therapist will convey understanding and empathy for what you are going through. To a great degree, the connection you have with your therapist is what determines the success of your therapy.

Change takes time and collaboration.
Meaningful change does not happen overnight. Many of these patterns of behavior have been honed over years and years, and take time to examine, untangle, and reintegrate into our current lives. Since this type of therapy is more likely to focus on meaning rather than symptoms, it takes time.

It has been written that psychotherapy could conceivably occur between two people without one of them being a therapist. Yet this is quite unlikely. The way that therapists listen, without generally offering advice or solutions, is not the usual mode of casual conversation. A conversation dedicated, on a weekly basis, solely to the concerns of one person is not likely to occur outside of psychotherapy.

Listening in an informed, sustained way.
A therapist will listen knowing what types of life events are likely to have an impact on one’s style of relating to self and others. A therapist will listen knowing that each stage of life (e.g., adolescence, young adulthood, parenthood, middle age, retirement) brings its own unique set of problems, and what are the usual hurdles during these stages. Finally, a therapist will listen with an understanding of the pathologies that can develop in responses to certain problems and have experience in working with those pathologies (e.g., depression, anxiety, obsessive behavior).

Kalea Chapman, Psy.D.

Body Position Affects Memory of Events

Fascinating piece at Cognitive Daily on headlined topic, from a 2007 study. One idea that occurs immediately, is that this idea lends credence to treatments for PTSD that involve physical movements, even re-dramatizing the event. Here’s an excerpt:

A new study adds an unexpected method to the list of ways to spur memories about our past: body position. That’s right: just holding your body in the right position means you’ll have faster, more accurate access to certain memories. If you stand as if holding a golf club, you’re quicker to remember an event that happened while you were golfing than if you position your body in a non-golfing pose.

Using Restraints in Public Schools

Today’s New York Times runs a shocking story on the use of restraints in public schools on children with special needs — autism, attention deficit disorder, retardation. The article contains a link to an interesting site that advocates for this group: special needs muckraker. Here’s a quote from the article.

In April, a 9-year-old Montreal boy with autism died of suffocation when a special education teacher wrapped him in a weighted blanket to calm him, according to the coroner’s report. Two Michigan public school students with autism have died while being held on the ground in so-called prone restraint.

Local Vicki Forman writes an excellent blog: “about being a writer and a mother and an advocate for my son who has special needs.” So far as I know, they haven’t had to deal with the use of restraints. Forman’s book on her experiences is slated for publication by Houghton Mifflin. You can check out her blog here.

Kalea Chapman, Psy.D.

Suicide Is Dangerous

Last week’s New York Times Magazine had an interesting article on suicide by Scott Anderson. At the outset, it should be noted that his article is basically about people that jump off bridges or buildings to commit suicide, “jumpers”. (John Grohol writes “Suicide Barriers Are Effective” here.) It’s always an important topic: Roughly 32,000 people commit suicide yearly in the United States. That makes it the 11th most common cause of death among adults.

This has to be less than 8 percent of all suicides. The rough breakdown of method according to U.S. statistics of suicide (2005) is: Firearms - 52 percent; hanging, strangling, suffocation - 22 percent; poison - 18 percent; all other methods - 8 percent. In fact here’s what they say at suicide.org:

Although many believe that jumping off a building or bridge (or falling) is a common suicide method (because when it happens there usually is a lot of news coverage about it), in actuality only about 2% of all suicides occur by this method.

Back to Anderson. He wonders why if 90 percent of all suicides are by people with “some form of a diagnosable mental disorder” then why haven’t “advances in the treatment of mental illness had so little effect?” Actually, here’s what the NIMH lists as one risk factor:

- depression and other mental disorders, or a substance-abuse disorder (often in combination with other mental disorders). More than 90 percent of people who die by suicide have these risk factors

So Anderson doesn’t mention the risk of alcohol or substance abuse, or that these are often co-occurring with mental disorders. Other possible answers to Anderson’s question: Not all those with mental illness seek treatment. Or, even those in treatment suffer from impulsiveness and difficulties with planning. Some risk factors, such as having a family member that committed suicide, cannot be “treated” in the usual sense.

Anderson answer is to address that outcome of suicide has less to do with the “why” of suicide (such as mental illness), but the “how” of suicide. Is the act premeditated or impulsive? Many impulsive suicides, Anderson suggests, are preventable. Anderson argues that jumping off a bridge is seldom premeditated, often impulsive. (He cites interviews survivors of attempted suicide by jumping.) And he offers an interesting case study:

In Northwest Washington stands a pretty neoclassical-style bridge named for one of the city’s most famous native sons, Duke Ellington. Running perpendicular to the Ellington, a stone’s throw away, is another bridge, the Taft. Both span Rock Creek, and even though they have virtually identical drops into the gorge below — about 125 feet — it is the Ellington that has always been notorious as Washington’s “suicide bridge.” By the 1980s, the four people who, on average, leapt from its stone balustrades each year accounted for half of all jumping suicides in the nation’s capital. The adjacent Taft, by contrast, averaged less than two.

Opponents to setting up a fence on the Ellington bridge argued that the suicidal would simply travel the hundred odd yards to the Taft bridge.

Except the opponents were wrong. A study conducted five years after the Ellington barrier went up showed that while suicides at the Ellington were eliminated completely, the rate at the Taft barely changed, inching up from 1.7 to 2 deaths per year. What’s more, over the same five-year span, the total number of jumping suicides in Washington had decreased by 50 percent, or the precise percentage the Ellington once accounted for.

The difference in the two bridges?

So why the Ellington more than the Taft? In its own way, that little riddle rather buttresses the environmental-cue theory, for the one glaring difference between the two bridges — a difference readily apparent to most anyone who walked over them in their original state — was the height of their balustrades. The concrete railing on the Taft stands chest-high on an average man, while the pre-barrier Ellington came to just above the belt line. A jump from either was lethal, but one required a bit more effort and a bit more time, and both factors stand in the way of impulsive action.

Essentially the article argues that many suicides are preventable. Anderson goes on to examine some interesting history of the Golden Gate Bridge. Since 1937 an estimated 2000 people ended their lives jumping off it. The details are quite interesting.

Depression is Real

John Grohol at PsychCentral points to an article on this topic at Anchor magazine. The Canadian-based magazine is in itself interesting — it’s tagline is “conquering depression” and appears to be a comprehensive site for anyone with questions about depression, or that suffers from depression. Topics included: Depression and — men, women, teens, research, healthy living, on call, destigmatizing, over 50, been there, and more. One of many things it includes is a blog.

Dr. Grohol points out that while he’s not “crazy about medicalizing depression” it does help people acknowledge that it is an actual treatable entity.

And definitely check out Anchor if you suffer from depression or know someone that does.

Can Boomers’ Brains Be Saved?

There’s a lot of marketing being done for ‘brain fitness’ devices and methods, and of course there’s big bucks to be made when your target market is baby boomers.

Interesting conversation going on between a few blogs on this topic. At Psych Central summing up a post at PsyBlog, asserts that the most evidence-based cognitive enhancer is exercise. PsyBlog’s post is a little longer, and really worth a look. There’s also a thoughtful retort, at SharpBrains, a site that markets tools for cognitive enhancement.

[P.S. Alvaro at SharpBrains has commented on this post and added additional links for further information on this topic. See Comments below.]

Part of what’s being argued is the value of evidence-based research vs. speculation about the effects of certain technologies or treatments, often based on some science to begin with. For some of the methods mentioned it’s quite difficult to isolate the effects via research (say, for instance, in meditation).

Each of these posts touch upon some interesting ideas about what might minimize the onset of Alzheimers or dementia — a concept known as the “cognitive reserve”. In other words, if you’ve spent an active, engaged life, you’ve got more “buffer” against these afflictions. Just a theory.

Here are some of the opinions from the PsyBlog post:

On computer programs:

Side-effects are probably limited to repetitive strain injury and a depleted wallet.

On a cognitive enhancers:

Amongst the chemical cognitive enhancers Modafinil is currently fashionable for grown-ups. But is it really that much better than caffeine? This study and this study suggest that in warding off sleep Modafinil is no more effective than caffeine - and caffeine is legal and readily available. Probably better to stick to tea or coffee.

On meditation:

Meditation still has to be considered unproven as a cognitive enhancer but it probably won’t do you any harm, plus it’s free.

And finally, on exercise:

The evidence for exercise boosting cognitive function is head-and-shoulders above that for brain training, drugs, nutritional supplements and meditation. Scientifically, on the current evidence, exercise is the best way to enhance your cognitive function. And as for its side-effects: yes there is the chance of an injury but exercise can also reduce weight, lower the chance of dementia, improve mood and lead to a longer life-span. Damn those side-effects!

And here are some thoughts from the SharpBrains retort:

What about traders, bankers or consultants who already frequent the gym often, but need help with stress management/ emotional self-regulation in order to remain “cool” when they need to? Would you tell them “Please stop trading/ that Board meeting when things get difficult, leave your desk/ room for 30-40 minutes to take a quick run, and everything will be fine when you come back”. Or would they better learn the cognitive skills needed to manage stress real-time via biofeedback or meditation, for example.

Third, as you point out, there are studies on specific groups of people (add/ adhd, dyslexia, stroke/ TBI) where well-directed cognitive exercise has shown an effect in well-designed trials, whereas physical exercise, to my knowledge, hasn’t to the same degree. We are talking about over 25 million individuals in the US in those 3 categories alone. What do you tell them?….

Fifth, while physical exercise has shown clear value in improving some cognitive abilities, such as some executive functions, it hasn’t show comparable value in others, such as information processing or memory. Which is one crucial reason why, in my view, looking for cure-alls will probably prove elusive.

Vacation

I’ll be out of town and not posting until July 11th at the earliest.

New Blog: Psychology Today

Mindhacks notes the launching Psychology Today’s formidable blog:

Popular psychology magazine Psychology Today have launched their own blog network with some of the biggest names in psychology, psychiatry and philosophy of mind regularly writing for it.

As a magazine, PsyToday has had a long reputation for being a bit populist and light on what most psychologists what actually think of as psychology.

That seems to have been changing in recent years and there’s been a consistent increase in the quality of the articles.

Depression Linked to Everything

Furious Seasons June 18 entry points out:

Depression Linked to Absolutely Everything, Solutions Elusive. A new study is out today in JAMA asserting a link between type 2 diabetes and depression and vice-versa. The study now joins reams of studies in recent years–many of them by non-psychiatrists, just to be clear–that link depression with seemingly every human malady and shortcoming. Heart disease, cancer, obesity, chronic pain, racism, poverty, smoking and so on have all been tied in with depression, locked in the kind of bio-psychological feedback loop that has doctors calling for depression screening and the inevitable push for treatment with anti-depressants (which themselves have been linked with diabetes causation in some studies just to make things even more confusing) and me scratching my head over what it all means. Because it does all mean something. And maybe nothing all at once.

Twenty-Fifth Edition of Brain Blogging Carnival

Brain Blogger’s 35th edition of the Brain Blogging Carnival. It includes these links. All the descriptions are straight from Brain Blogger. There are about 15 other interesting stories to delve into, but here are a few:

Read or Die! presents Increase your Brainpower now!:

As I was reading the January issue of Reader’s Digest mag I found these tips on how to increase brainpower. Check them out; these might help you prepare yourself before taking an exam or before taking the MENSA test.

Sharp Brain presents Cognitive and Emotional Development Through Play:

Play is rapidly disappearing from our homes, our schools, and our neighborhoods. Over the last two decades alone, children have lost eight hours of free, unstructured, and spontaneous play a week. More than 30,000 schools in the United States have eliminated recess to make more time for academics.

Read or Die! presents Increase your Brainpower now!:

As I was reading the January issue of Reader’s Digest mag I found these tips on how to increase brainpower. Check them out; these might help you prepare yourself before taking an exam or before taking the MENSA test.

The Next 45 Years presents 30 True Things You Need to Know Now:

If the map doesn’t agree with the ground, the map is wrong. We are given mental maps as children. Our parents and other adults tell us what is right and what is wrong – sometimes they don’t always get it, well, right. Now as adults, when we find the maps we have relied on for so long can get us lost, we need to recalibrate and create more reliable guides based on what we now know to be true and where we want to go.