Talk therapy provides enduring relief from depression years after treatment, study finds

From PsyPost on 07/19/26

Talk therapy provides lasting relief from depression, with the benefits persisting for several years after treatment ends. A new, large meta-analysis evaluating tens of thousands of patients tracked these mental health improvements over time, mapping exactly how long people feel better. The research was published in the journal World Psychiatry.

For more click here.

A few note worthy points:

1. Talk therapy may be more helpful than medication.
2. Talk therapy benefits are long lasting over several years.
3. In general, maximum benefit is achieved at about 3 months.
4. "Talk therapy" is professionally referred to as "psychotherapy" and colloquially as "counseling."]
5. "Psychotherapy" is much different than simple conversation because the therapist knows the most helpful questions to ask to explore areas that will be most helpful to the client and is ethically bound to put the client's needs ahead of their own.

MAID, Medical Assistance In Dying, available in New York State as of 08/05/26

On 07/18/29 I took an online CEU course from the Wurzweiler School of Social Work at Yeshiva University on “Understanding Medical Aid In Dying: Clinical, Policy, and Caregiver Perspectives.” There are 14 jurisdictions that now allow MAID with New York State’s more recent law taking effect on August 5, 2026. MAID is also legal in Canada and many other countries.

Self administered end of life chemicals is not called “suicide” by people in the field. Terms such as “death with dignity” are preferred. Also, MAID is not euthanasia. Euthanasia is ending life by another and it is illegal in all jurisdictions in the US although allowed in some other countries.

Here is a brief YouTube video about Barbara Goodfriend’s MAID experience on CBS Eye On America broadcast on January 28, 2025.

This the first in a series of article on MAID which will be tagged MAID.

Psychotropic medications and human functioning.

There is a very good book entitled “The Social Worker and Psychotropic Medication” by Kia Bentley, Shannon Hughes, and Joseph Walsh which attempts to cover what Social Workers should know about psychotropic medications.

When I graduated with my MSW in 1972 psychotropic medications had not yet been formulated and used in the treatment of symptoms of mental health problems. Psychodynamic oriented psychotherapies and custodial care were the predominant treatment strategies. The bio-psycho-social model of assessing problems in functioning was not described until 1977 by Dr. George Engel at the University Of Rochester. The Social Work knowledge base has always focused on what Social Workers called the “person in situation” model. 

Over the course of my 58 year career as a Psychiatric Social Worker I have learned about psychotropic medications and their effects on human functioning from “on the job training” and reading journal articles and books. It is interesting how the predominant treatment of symptoms of mental health problems has shifted from the psychological to the pharmacological. Some of this shift has been beneficial and some of it has been harmful. A good Social Worker is aware and educated about both.

The key question from a Social Work perspective is “How do psychotropic medications affect human functioning?” A corollary question is “what professional discourse is most helpful in assessing how psychotropic medications enhance or detract from human functioning?”

Monitoring effects of psychotropic medications.

As a Psychiatric Social Worker, and not a physician, I still spend a lot of time and energy discussing with my clients their medications, especially their psychotropic ones with them. 

Knowing about the power of the placebo effect I am very cognizant and curious about what my clients think about their medications. Do they think they will help, are skeptical, or have mixed feelings? Will they be compliant and take them as prescribed or “forget” to take them or abuse them?

There is a fine line between medical and psychological effects of taking medications. Many of my clients expect medications to be a “silver bullet” and a “magical key” to ameliorate their symptoms and improve their experience of their quality of life.

Whether medications “work” has as much to do with psychological expectations as well as the pharmacological actions. Whose job is it to monitor the efficacy of the use of medications: the prescriber, the psychotherapist or both? 

Throughout my career as a Psychiatric Social Worker I have increasingly found that it is my job if I want to help my clients improve their functioning. I find myself surprised at the lack of supervision by the prescriber on the psychological dynamics of prescribing medications. They don’t seem to have the time for it or an interest or competence in this aspect of their patients' treatment. They leave it up to the psychotherapist if the patient has one.

For more on this topic click here.

Does availability of mental health services make a difference?

I asked myself  last week what I had to show for my work after 57 years as a Psychiatric Social Worker in New York State. I decided to investigate further and here is part of what I found. New York is ranked as #1 in mental health and well being among all the US states according to Mental Health America in 2025. There are seventeen indicators that are measured to determine these rankings one of which, is “thoughts of suicide in the past year.” New York is ranked third lowest suicide rate in the nation after District of Columbia and New Jersey. 

In my career I have estimated I have done over 15,000 suicide/homicide evaluations most of them in large urban emergency rooms after an attempt was made or the person was bought in with a mental hygiene arrest. How many lives working as part of a mental health system team have been saved? Compared to other states, very many.

The national average suicide rate stands at 13.7 deaths per 100,000 people. However, individual state rates vary dramatically—ranging from a low of 5.7 to a high of 29.7.

In general, the highest rates are concentrated in the Mountain West and Alaska, while the lowest rates are primarily found in the Northeast and California. The rate in New York is 8.3 far below the national average. 

If mental health professionals were to build a mental health system that prevented deaths from suicide what elements in that system would be beneficial to that goal?

The glaring discrepancy in suicide rates is rarely recognized and acknowledged let alone addressed. For example the suicide rates in the worst states: Alaska 29.7, Wyoming 27.8, Montana 26.8, Oregon 20,0 and the best states: New Jersey 6.7, New York 8.1, Massachusetts 8.3, and Rhode Island 8.9 is very significant with the rates in the worst states being three times higher than the best states.

One of the biggest factors in suicide rates is the quality of the infrastructure that supports personal functioning. In other words, does a person have a place to turn when they are down and out? Is there help available? 

Mr. Rogers said that his mother told him, “Freddie, if you are in trouble look for the helpers.” Mental health professionals are a type of helper. The concern is that they are available  to meet needs of ultimate desperation. In some states that are more available than in others. The public health data of suicide rates is one way of measuring the difference their availability makes in the health and life of a population,

Lula Dean's Little Library Of Banned Books

 I noticed this morning, July 2, 2026,  that Kirsten Miller's book, Lula Dean's Little Library Of Banned Books, kindle version, is on sale for $2.99. I read it a couple of months ago and it is very enjoyable and illuminates the dynamics of book banning in our current society.

How it works: Small talk is beneficial

When it comes to small talk it is the process not the topic that provides benefits to the participants.

An interesting study asked people to predict how satisfied engaging in small talk about things like the weather, current events, traffic, etc. People prior to the small talk conversations rated the satisfaction as being low, but after the conversations rated their satisfaction much higher. Why the discrepancy between predicted and actual satisfaction? 

One explanation is that people based their prediction of satisfaction on the topic not the dynamics of the social interaction.

Is it worth engaging in small talk with people? The research finds that yes for most people it is. Observe your own experience and report your findings in the comments. I would like to know what the results are if you intentionally observe your experience.

For more click here.

Good work noted: Mental Wealth project at University of Sydney

 

Mother Teresa said that the US while the wealthiest nation on earth is also the most spiritually impoverished. The Beatles sang "Money can't buy you love."  Americans are very focused on money as the measure of success. The Stoics taught that the development of virtue is the proper measure of success.

How it works: Conspiracy thinking

 

Conspiracy thinking considered from a cognitive developmental model is immature and based on an egotistical desire for security in what is perceived as a confusing and threatening world. People who engage in conspiracy thinking should be approached with compassion without condescension and a passive non threatening friendly suggestion to consider other optional understanding of the phenomena under consideration.

How do systems work?

One of the obstacles to satisfying and fulfilling functioning is the lack of understanding of how systems work. Most of the systems that comprise modern life are complicated and thus confusing, frustrating, anxiety inducing, and can seem overwhelming. As a Psychiatric Social Worker I spend a lot of effort and energy in helping clients navigate the various systems that can provide the resources for them to meet their needs and are requiring some degree of compliance, cooperation, and behavior. This assistance requires that the Psychiatric Social Worker understands how these systems work. This understanding requires education and experience. This understanding of how systems work is a major component of Social Work competence.

The assistance in navigating systems is sometimes referred to as “empowerment.” Empowerment involves three activities: providing information, teaching skills, and providing opportunities to use that information and those skills.

What are the major systems that people function within in our current society? Some of them are education, health, legal, economic, recreational, media, social welfare, and political. Within these domains there are multiple subsystems.

Here on Markham’s Behavioral Health we will be exploring how these various systems work and how they can best be navigated to obtain what resources they provide to improve a person and their family’s functioning.

The overarching question is how do these systems affect a person and community’s mental health?

Michel Foucault called these systems “discourses.” Discourse analysis involves several components of the discourse: knowledge, skills, values, expert representatives of the discourse. One of Foucault’s great contributions was to analyze discourses historically and trace their development in society over time usually involving a couple of centuries or more. Understanding discourse development historically gives the student a better understanding of how the discourse’s knowledge, skills, values, and expertise evolved and came to be what they are today.

The first discourse to be described on Markham’s Behavioral Health is the health care system in the United States which is, compared to other first world countries, very dysfunctional and increasingly difficult to navigate to get one’s health care needs met. It is hoped that by better understanding the system one can better manipulate it to get one’s health care needs met and to help change it to a system that better meets the needs of the American people.

People learn poor interpersonal skills from their parents in their first 6 years.

From The Conversation 06/09/26, "Kids learn to bully from adults’ threats, manipulation and criticism – a child psychologist explains how parents can model better tactics"

Think about all the ways you can get someone to do something that’s undesirable to them, especially if you have power over them. You can use positive tactics, such as direct encouragement, incentives and praise. You can try negative tactics, such as threats, manipulation and force. Some – asking politely, saying please and thank you each time – work better than others, such as nagging or pleading.

Children learn which tactics work and are acceptable by seeing how adults, who hold power over them, employ them.

On one extreme, observing aggression between parents increases risk for children’s heightened aggression and violence in their own social relationships. Stanford psychologist Albert Bandura’s seminal 1961 “Bobo Doll Study” found that preschool children who saw an adult hit and kick a life-size inflatable figure were more likely to be aggressive toward that figure when frustrated.

In my own research, I focused on children who were exposed to domestic violence between parents as early as in infancy. As adults, these now-grown children were more likely to be both victims and perpetrators of violence with their romantic partners. People were particularly likely to be violent as adults if they were exposed to domestic violence when they were in preschool, as opposed to later in childhood, suggesting early childhood is a particularly important time for parents to model healthy conflict resolution.

Parents and other authority figures teach young children better by what they do, how they behave, than by what they say or as the aphorism is stated, "Actions speck louder than words." 

At age 80 I reflect on how my ex-wife and I modeled conflict resolution for our 9 children and I realize now that it was pretty dysfunctional and had a negative influence on our children. There is not much to be done about it now but admit our mistakes and ask for forgiveness.

The key skill children learn is how to use power in their interpersonal relations. Sometimes this is described as "control issues." There are things that children want to do that they are told they can't, and things that children don't want to do that they are told they have to. These conflicts lead to power struggles. The interesting thing to observe is who is going to win and how do they do it, and what are the consequences of getting one's way?

Are there better ways of resolving these conflicts than others? Yes. What are they?

Community programs mitigate opioid deaths significantly.

David Wazana has written a great article for the Rochester Beacon entitled, "Rochester joins effort to raise naloxone awareness." which was published on June 12, 2026. 

Rochester’s Neighborhood Ambassador Program, a city-funded, community-driven program, seeks to address the opioid epidemic by recruiting and training neighborhood ambassadors in opioid crisis interventions. NAP also distributes naloxone kits, which contain naloxone nasal sprays and strips to test for fentanyl and xylazine.

According to preliminary data from the Centers for Disease Control, 2025 saw an almost 14% decrease in overdose deaths; New York, along with Rhode Island, North Carolina, Alabama, and Vermont, saw the largest decline, with 25% fewer overdose deaths in 2025 than in 2024.

_______________________

In Monroe County, opioid-related overdose deaths dropped from 433 in 2023 to 216 in 2024, a decline of 50%, according to recent data from the county medical examiner. The decline mirrors a national trend, which researchers and advocates like Klee attribute to harm-reduction efforts and increased access to Nalaxone, as well as growing awareness of the dangers of opioid use.

In 2023, at the height of the nationwide opioid epidemic, opioid overdose deaths peaked at 79,000 before beginning a steep decline, which has continued since then.

I have known many people professionally and personally who have died from opioid overdoses. I also know of people who have been saved from dying by the quick administration of naloxone.

Deaths from naloxone overdoses are devastasting for families and communities. In attempting to counteract these loses it is important to know, support, and utilize harm reduction strategies. The data indicates that they work saving lives and improving the health of individuals, and the well being of families and communities.

As a side note, David Wazana's article is a great example of solution oriented journalism. Kudos to him for his good article and for the Rochester Beacon for publishing it.

The Platinum Rule

As a child, I greedily absorbed the many books I read as visions of alternate lives. Now, still capable on occasion of the same sort of greedy absorption, I am also aware of books as structures of language and of specific problems that they set out to address.

Spacks, Patricia Meyer. On Rereading (p. 46). Harvard. Kindle Edition. 

As a Psychiatric Social Worker I have been taught and learned that the skill of empathy is essential to good Social Work practice. In order to become skilful in empathy a person can practice the “platinum rule” which is to do unto others as they would have you do unto them. To practice the platinum rule one must know how others, especially those different from oneself, want to be treated. How does one learn this? The easiest way is through reading and rereading. As Spacks puts it, to experience “visions of alternative lives.” In reading books and working with people from different cultures, religions, generations, etc. I often feel like a voyeur. This is one of the reasons I enjoy my profession so much. I am endlessly curious about other people’s lives and experiences.

Intolerance of ambiguity can be a problem creating more problems

Some people tolerate ambiguity better than others who tend to see the world in black and white. The intolerance of ambiguity results in psychiatric symptoms of control, anxiety, depression, irritability, and compulsive behaviors such as drinking and drugging, pornography abuse, over working.

My mother used to call people who overthink things "worry warts."

How can people who have difficulity tolerating ambiguity and uncertainty be helped? The easy strategy for symptom relief is medication whether licitly subcribed by a health care professional or self administered having been obtained "off the street."

People who have difficulty with ambiguity have what is sometimes called an "insecure attachment style." Trust is a big challenge since negativity and pessimism are predominant thought processes. It helps if the person has relationships in which partners are reliable, honest, predictable and "there for them." The partner being non anxious, secure, and able to tolerate ambiguity is reassuring and soothing and the insecure person is able to "lower their guard" a bit and take a few bricks out the wall that they have surrounded themselves with to protect and defend themselves from the threat of future hurt.

People with difficulty tolerating ambiguity often are over controlling, rigid, stubborn, have a need to be right about everything, and insist that things be just so as they expect and demand. People they are in relationship with and trying to control often object to this style of interaction and the very things the controlling person was afraid of happening, happens. The attempt at controlling, and the other person objecting, rejecting and abandoning the person, is the very thing the person was trying to avoid by being so controlling in the first place and so there is a vicious cycle with the interaction escalating unitl a rupture occurs. In the extreme this interative pattern can lead to intimate partner violence, IPV.

Medications will not change the interpersonal activities engaged in this problematic situation. Often outside therapy individually and sometimes with couples and families can be helpful. The person with difficulty tolerating ambiguity needs help in managing their anxiety generated by uncertainty so they can manage their individual and interpersonal functioning in a more satisfying and fulfilling manner.

For more click here.

Being alone with your own mind

As far as being left with one's own mind goes, the biggest barriers and obstacles to facing oneself is fear and guilt. In our psychiatric discourse, fear is described as "anxiety" and is medicated, and guilt is described as "trauma" and "PTSD" and is subject also to medications and EMDR and CBT.

Guilt, though, is a fundamental existential awareness that we have separated ourselves from our Transcendent Source and that Source will punish us for our egotistical belief that we can be the author of our own lives. This fear of punishment for our separation contributes to all kinds of psychiatric symptoms, the greatest of which is the feeling of being victimized for whatever reasons we can conjure up to blame others for our unhappiness.

In AA people are encouraged to face themselves in the fourth step which few people do unless they are interested in actually working the twelve step program.

Peace, which we all yearn for, is based on facing ourselves and joining once again with our Transcendent Source whatever we conceive that Transcendent Source to be. Psychotherapists are walking with people as we all go home. 

Tension is a characteristic of an emotional system

The systemic tension is in the system not in solely in one part although one component is sometimes known as the "symptom bearer." But the symptomatic member of the system can change rapidly as in "hot potato, hot potato, who's got the hot potato."

One person in the system is sometimes scapegoated because it serves the other parts of the system and maintains system homeostasis. Systems, to main homeostasis, often engage in human sacrifice.

Having been trained as a strategic family therapist, I was taught to ask, "What is the function of the symptom for the system?" When we look at the high levels of systemic tension in the United States today where fingers point to many scapegoats, as therapists looking at the system dynamics, we might ask where we can best intervene to jog the system onto a better level of functioning? When we make these interventions, they may cause, initially, an increase in stress because the system is destabilized and thrown into disequilibrium, which is a good thing if change is to occur, but as the therapist, we need to professionally and responsibly guide this restabilization to a more constructive, healthy way of functioning.

Nonviolent advocacy is the better way to go than further violence or even resistance alone. So the question we might ask ourselves is what do we love and how do we bring it about. Martin Luther King, Jr. was not against racism per se, but was an advocate for justice the arc of which bends slowly but inevitably to making heaven on earth when everybody loves everybody all the time.

How do we do this? One person at a time. I can love the sinner, but hate the sin. We can commit ourselves to stop wringing our hands and do something good today to somebody who crosses our path. This can be challenging in difficult times, but something that we psychotherapists are committed to.

Who should I love? - Watch Video

Social safety net involvement to lower anxiety and stress

One of the four quadrants in Ken Wilber's AQAL metaphysical model is the scientific quadrant.  The other quadrants are the subjective, the cultural, and the institutional. Looking at the problem of "insecurity" defined as people and groups feeling unsafe and vulnerable contributing to hypervigilance, reactivity, and chronically high levels of stress from the perspective of culture and institutions, we might wonder what it takes to reduce the high levels of tension in the system? We do this by introducing mechanisms that promote security and the decrease in fear both in individuals, in small groups, in communities, and in larger societies.

This reduction of fear and nurturing of security takes what we colloquially call the provision of the "safety net." Safety net infrastructure is being eroded and eliminated by those who want to control the society through autocratic leadership that enriches the few at the expense of the many. Finding social means of increasing equity, justice, and compassion contributes to a heightened sense of public safety and individual safety. These social means of increasing equity, justice, and compassion are more likely to be realized through mutual aid in our current autocratic political system rather than through governmental support.

So the answer to the question of how to help people lower their insecurity and stress levels in our current political environments is the encourage the befriending of neighbors and volunteering to nonprofit organizations in one's community that address the meeting of basic needs such as food, housing, health care, education, and public safety. Each person has a finite amount of time, talent, and treasure which they can contribute to the common good. It is in providing mutual aid in these basic domains to enhance equity, justice, and compassion that will lower the tension level in our social systems. There are plenty of social science studies which demonstrate the benefits of this focus and activity, but they are not well known, taught, or implemented.

What social programs do you know of, support, or have benefited by?

Social safety net involvement to lower anxiety and stress - Watch Video

states with lower gun ownership and stronger gun laws have the lowest suicide rates.

For National Suicide Prevention Week, which is held each year during National Suicide Prevention Awareness Month, we released our annual analysis of state-by-state suicide rates. Year after year, the analysis reveals that states with lower gun ownership and stronger gun laws have the lowest suicide rates. Conversely, the states with higher gun ownership and weaker gun laws have the highest suicide rates 

For more click here.

Some might say that gun violence is as American as Apple Pie. This idea is indicated by the fact that there are more guns in the US than people and Americans possess more guns than any other people in the world.

When gun violence occurs the politicians ask for people's "thoughts and prayers," as if thoughts and prayers will address the tragedy that continues to occur in any meaningful way. How about if instead of thoughts a prayers the politicians focus on gun safety laws like we do with automobiles, planes, and the misuse of substances.

The mortality rate from guns in the US is a significant public health problem and until it is managed as such the gun mortality rate is not likely to change.

New York State has the third lowest suicide rate in the U.S.

When I was in graduate school getting my MSW in the early 70s our class was divided into groups and we had to pick a social problem area to research, study, and report on to the whole class. My group picked suicide.

In my career I worked for 18 years as a "psychiatric assignment officer" in 3 large urban hospitals doing mental health and substance abuse evaluations and dispositions. I estimate over those 18 years I did over 14,000 suicide evaluations.

Over my 56 year career I have continued to follow the suicide data and recently found the suicide rate for 2022.

The states with the lowest suicide rates are NJ with 7.7/100,000 followed by MA with 8.3, NY with 8.5, ML with 9.5, and CA with 10.4.

The states with the highest suicide rates are MT with 28.7, AL with 27.6, WY with 25.6, NM with 24.7 and ND with 22.5

It is very interesting that suicide rates vary by as much as 3 - 4 times as much in the highest rate states from the lowest rate states. It is interesting that suicide rates are much higher in red states than in blue states.

Why do you suppose the rates vary so significantly from state to state?

Open letter to mental health professional colleagues as they witness the pain of their clients.

A colleague wrote in part : “This has been an ugly week of multiple clients upset with the executive orders. The thing that continues to strike me is how der Trumpenfuhrer embodies the sum of all fears…..I spent two hours on Zoom today with crying people in the midst of the total meltdown of their lives, having lost jobs in the past several months and now worried about the ways in which the executive orders will effect them and the world. It was an ugly day.”

My reply is below:

It seems very important for therapists to support one another in what they are observing and experiencing. Vicarious trauma may be on the rise in our profession when therapists witness and describe days like the one you just had.

Psychopaths like pain. Inflicting pain is the point because it makes them feel powerful. Perhaps one of the most challenging things for therapists to observe and attempt to mitigate is cruelty and sadism.

In recent days not only is cruelty and sadism being perpetrated but it is being normalized with "pardons" that lift external constraints and restrictions and allows those so inclined to behave in further cruel and sadistic ways with impunity.

As I learned working on inpatient psych units and psych ed, what works best with these behaviors is injections of Haldol and four point restraint with a skilled team trained to exert a "show of force". These tactics are used only after de-escalation techniques have failed.

After such interventions staff always met for a brief de-debriefing so that calm could be restored and confidence in maintaining safe order was reinforced.

As therapists we need to find ways to keep each other safe so we can keep our clients safe as best we can.

Remember, cruelty is not a byproduct of what is being perpetrated, but the cruelty is the point to dominate, coerce, and subjugate. It is important for us as MH professionals to confront it head on, lean into it, and mitigate it. Some of us will be harmed in the process, but in the end justice, compassion, dignity, and peace will be achieved.

Keep the faith. Stay strong. Be courageous, Do the right thing. Focus on what matters.