Showing posts with label psychotherapy. Show all posts
Showing posts with label psychotherapy. Show all posts

Monday, October 31, 2022

The Power of Stories

 

Stories provide a moral model of the world. They teach how things work or could work. The question is what does the audience make of the story? What does it tell them about the kind of person they are, other people are, and the world they are living in?

Does the story enlighten and uplift or deflate and demoralize?

Stories are the basis of psychotherapy. Psychotherapy is about the client's story or the couple's story or the family's story, or the community's story, or the society's story.

The significant point here is that stories matter. Tell stories with care.

Sunday, October 30, 2022

What is the goal of psychotherapy?



Along with this idea is the one that the presenting complaint is not the real complaint. The presenting complaint is just the ticket of admission. The presenting complaint is what the client thinks they are supposed to say, based on their socialization, which makes them an appropriate candidate for psychotherapeutic service.


If you ask most people “What makes you tick?” They become perplexed, annoyed, and defensive. It is in this question that psychotherapy begins.


Psychotherapy is not the same thing as “counseling” and “life coaching” and “emotional management skill training.” Psychotherapy is a much more significant, challenging, and revealing journey into the self.


On this journey what will one eventually find? Our Transcendent Source. The basis of our Divinity.


Tuesday, June 14, 2022

Your provider will be with you shortly

 Clearly there must have been “something in the air” in the mid and late 1980s, some shift in the zeitgeist of psychotherapy, that made psychotherapists and their development more salient in the minds of researchers. Previously almost all scientific attention in the field had focused on therapeutic procedures, the “techniques” that therapists used (e.g., “interpretation” or “accurate empathy”), the processes that evolved in therapy from their use (e.g., “insight” or “self-acceptance”), and their impact on the patient’s mental and emotional condition (i.e., “outcome”). In many ways this model still largely persists, based on the assumption (imported from biological medicine) that the “curative effect” of psychotherapy derives from effective treatment procedures correctly applied to specific disorders. In this highly sanitized “laboratory” model, physician-therapists are viewed as well-trained administrators of the therapeutic procedure, with all other personal and professional characteristics an irrelevance; and they are essentially interchangeable. 8

Orlinsky, David E.. How Psychotherapists Live (p. 4). Taylor and Francis. Kindle Edition. 


The bolding has been added.


The commodification of psychotherapy based on medical “procedures” is inherently flawed and yet drives the reimbursement systems from health insurers. It has led to the corporatizing of “psychotherapy” in on-line schemes to provide psychological advice even via text messages for monthly service fees charged to a credit card.


What do you make of this?


Recently, at my last medical check-up the LPN took my weight, my temperature, my blood pressure, checked my medication list, and then got up to leave saying “Your provider will be with you shortly.” I was startled by the choice of the word “provider.” I wonder who had scripted her to say instead of “your doctor” or “Dr. Alweis”, “provider.”. And then it dawned on me that this is a large practice and she is “rooming” several patients all day long some of whom are seeing physicians, other P.A.s, some NPs, and some residents. “Provider” covers a lot of roles and professions and is a safe word to use when the discipline of the “provider” isn’t certain. They all to some extent are interchangeable. 


In my solo private practice of psychotherapy, there are no “providers.” There is only one Licensed Clinical Social Work Psychotherapist. I ask, “How did you get my name?”


 “Oh, my parents saw you twenty years ago. They told me you are good. You helped them.”


“You could go online and talk to someone like BetterHelp.”


“Oh I tried them for six visits. I decided I wanted to talk to a real person.”


“It’s nice to meet you.”


“Same here.’


Sunday, May 29, 2022

How can you do this work?

Purely in human terms, psychotherapy is an intensely interesting and often personally impactful experience, dealing as it does with personally traumatic events, enduring emotional conflicts, difficult intimate relationships, and challenging moral dilemmas of personal life. 2 Given the kind of work they do, it follows that psychotherapists must also be interesting people. It must take a special kind of person to do such work, day after day as a lifetime career. Yet how are they special, if at all? What are they like as persons that enables them to do such challenging work? Are some kinds of persons better able than others to do this work? Is there a special psychotherapeutic talent? What kind or kinds of persons feel called to learn, practice, and tolerate the kind of work that psychotherapy entails. 3 What does a psychotherapeutic vocation require of those drawn to it?


Orlinsky, David E.. How Psychotherapists Live (pp. 1-2). Taylor and Francis. Kindle Edition. 


I had read Sue Mann’s article, “How Can You Do This Work?”, in Trauma, Narrative Responses To Traumatic Experience edited by David Denborough in which she describes her work as a counselor in an agency serving adults who were sexually abused as children. Sue describes sharing with others, who ask, what she does for a living, and them, then, saying, “How can you do that work?” Throughout my career of 49 years, I have continually reflected on this question myself. 


How can you do the work of a psychotherapist? What motivated you to get into the field, and what keeps you in it, or contributed to your leaving.


Thursday, December 9, 2021

Majority of psychiatrists no longer provide psychotherapy


Researchers analyzing 21 years of data found that the percentage of psychiatrist visits involving psychotherapy has declined by half -- dropping to only 21.6 % of patient visits. Over half of U.S. psychiatrists no longer practice any psychotherapy at all. The study found that for rural, Black, Hispanic, and Medicaid patients psychiatrists' provision of psychotherapy was exceedingly rare.

For more click here.

Editors note:

I have observed this for some time going back even before the 1990s. 

Psychiatrists have become primarily pharmacologists who prescribe medications. 

Most psychiatrists are not even being trained to provide psychotherapy. By comparison a Licensed Clinical Social Work Psychotherapist in New York State must have six years of supervised training before they can become licensed to provide psychotherapy.

Monday, September 2, 2019

Pscyhotherapeutic fads


Question: When it comes to psychotherapy why do some therapists seem drawn to techniques which are fads that come and go?
Answer: Having been in the field 50 years now I have watched so many fads come and go with all kinds of trainings and certifications and egotistical claims that my type of therapy is better than yours because I have learned this recent technique and have been certified to deploy it.
The belief in magic is alive and well in our psychotherapeutic field among practitioners who have forgotten what Helen Harris Perlman taught us back in the 50s that good “casework” as it was called by Social Workers way back then is all about the “helping relationship.”
I have been reading Stephen Bacon’s book about Practicing Psychotherapy In Contructed Reality in which he suggests that the therapeutic variable might be the therapist’s “charisma.” Using Bacon’s idea, I suppose that if a therapist thinks his or her certification in the lastest therapeutic fad gives him/her more confidence and “charisma” and it fits for the client, then maybe the certification is an advantage, but I suspect that this misfounded belief in a magical technique just as often, or even more often, undermines a therapeutic connection especially if the technique is not perceived by the client as all that relevant.
I had a client tell me last week that she left her therapist because all the therapist wanted to do to her was EMDR and she didn’t see the point. The therapist, she said, didn’t seem to want to listen to her so she sought help elsewhere.
I got a PESI brochure last week for a workshop leading to certification in “tapping”. Wow! I guess if EMDR doesn’t work, there is always “tapping.” It seems odd that professionals with at least a Master’s degree and sometimes a Doctorate are enamored with this snake oil.
It is difficult to find good psychotherapy, sometimes, in the psychobabble hurricane which surrounds us.
What works in psychotherapy is not techniques, but the attentiveness and listening skills of the therapist. Does the therapist want to hear your story and ask you questions to further clarify the events, experiences, and meanings in your life? Does the therapist ask about and seem interested in helping you develop a preferred story in which you envision your better self and your better life? This exploration of your existeing life story and preferred story takes time and attentive listening. In this process, therapist and client, couple, family, group join together to pursue a better life free from egotistical concerns that can frighten, sadden, and anger. Good psychotherapy should result in peace and joy and a significant reduction in chronic anxiety and tension levels.

Monday, July 31, 2017

Cognitive behavioral therapy improves functioning for people with chronic pain, study shows

From Science Daily on July 11, 2017

Cognitive Behavioral Therapy (CBT) is the most frequently used psychological intervention for people with chronic pain, and new approaches for improving CBT outcomes may be found in the psychological flexibility model and Acceptance and Commitment therapy (ACT), according to research.

Editor's note:

There are many reasons why psychotherapy can help people suffering from chronic pain. Stress often aggravates pain and reducing stress may then decrease pain. Also, making a distinction between "pain" and "suffering" is helpful. Some people may have lesser amounts of pain but suffer greatly, while others have higher amounts of pain and suffer much less. Why would this be?




Friday, June 30, 2017

What Kind Of Therapy Is Best For Me?

What kind of therapy is best for me?
By David G. Markham, L.C.S.W.
Question:

I have been depressed and unhappy for many years, and have finally wondered whether psychotherapy can help me. I have done some reading and talked to friends and I know that there are psychoanalytically trained therapists and cognitive behavioral therapists, and people who do all kinds of therapy. I found a web site which said there are over 500 different kinds of psychotherapy. I even wonder if hypnosis would help me?  How can I choose what kind of therapy would be best for me?

Answer:
You have asked an excellent question and one which many people find perplexing. There are many ways I could answer your question. Let's start with the practical approach first.

I think the best way to find a therapist is to ask friends, relatives, your doctor or pastor if they know of a good therapist.  I think the best way to find a therapist is the same way to find any professional, by asking other satisfied clients.

A more conceptual way of answering your question would be to share a little bit about the therapy field. There are many schools of therapy which have their own training programs and credentialing standards. These programs  "certify" the competence of the practitioners in their method. The fact is that competence does not equal effectiveness. In other words, a practitioner can be very competent and heavily credentialed but still not help the client achieve any better outcomes than someone less well trained. This seems to be a puzzle in the field. Often psychotherapy training programs and institutes claim that their credentialing standards exist to protect clients. Interestingly, there is no evidence that any particular model or technique gets better results than others when scientifically evaluated.

When researchers examine the outcome in psychotherapy they find that the variables which contribute to good outcome are as follows: extra-therapeutic factors 40%, relationship factors 30%, hope and expectancy 15%, model and technique of the therapist 15%

Extra-therapeutic factors include things like persistence, openness, faith, optimism, supportive family, membership in a religious community, satisfying work, good friends, enjoyable hobbies, and all the other positive things in a client's life before they enter therapy.

Relationship factors include feeling understood by the therapist, having trust and confidence in the therapeutic relationship, feeling cared about, etc.

Hope and expectancy sometimes has been referred to as the placebo effect, that is, does the client believe that therapy can help? The more the client believes that therapy can help, the more likely it is that it will.

The model and technique of the therapist only accounts for 15% of the outcome, while the other three factors account for 85% of the likelihood of a positive outcome.

So, to answer your question about how to choose a therapist, I think it is important to find a therapist whom you feel understood by, whom you come to feel you can trust and put your confidence in. A couple of visits should be enough to make this determination. If you have met with a therapist two or three times and still don't feel understood by that person, or feel you can trust and put your confidence in that person, it is not that psychotherapy can't help, it is just that you have a bad match and you should save your time and money and try again with someone else.

The outcome research is very clear that psychotherapy does help and that the majority of people who use psychotherapy report improvement in as few as 4 sessions.

The overall length of therapy depends on the client’s goals and purposes. In a crisis, most clients find things improving in 4 to 8 sessions. For other problems and concerns, clients may want to continue in therapy for several months. It usually isn’t necessary to meet with the therapist weekly after the initial phase of therapy (the first 3 or 4 visits) and clients may want to meet with the therapist every other week or every three weeks, or once per month. Sometimes people want to see how things go for a period of time and return on an as needed basis.
Usually within a month or two, most clients find that they are managing things more effectively in their lives, and they are feeling better.

Reference ; The Heroic Client, Barry Duncan and Scott Miller, San Francisco: Jossey-Bass, 2000, pp.56-61

Saturday, March 11, 2017

Psychotherapy normalizes the brain in social phobia

A study conducted by researchers from the University of Zurich, Zurich University Hospital and the University Hospital of Psychiatry Zurich now reveals that the successful treatment of an anxiety disorder alters key brain structures that are involved in processing and regulating emotions.
Cognitive behavioral therapy pivotal
In patients suffering from social anxiety disorder, regulation of excessive anxiety by frontal and lateral brain areas is impaired.
Strategies aimed at regulating emotions should restore the balance between cortical and subcortical brain areas.
These strategies are practised in cognitive behavioral therapy (CBT) which is a central therapy for social anxiety disorder.
For more click here.

Tuesday, February 28, 2017

Benzodiazepines Continue to be Prescribed Without Psychotherapy to Older Adults

From Mad In America, 02/24/17

"A new study, published in the Journal of the American Geriatric Society, finds that older adults continue to be prescribed benzodiazepines without being offered psychotherapy. This practice persists despite decades of research warning of safety concerns with these drugs and demonstrating the effectiveness of alternative treatments."

I have a few "geriatric" clients in my practice. When they get off the benzos which is difficult because of the withdrawal which exaggerates the symptoms, such as anxiety, for which they were prescribed to begin with, they usually report that they feel better. I usually suggest they only take them if absolutely needed, and don't take them on a regular basis to avoid the development of physical tolerance.

Listening to older people's complaints takes time, time the primary care physician is not reimbursed for in our mercenary system of health care. There are many barriers and obstacles to the PCP referral to mental health professionals, but when done and psychotherapy is engaged in, benefits are worth in the cost in most cases.