Suicide rates by country

The suicide rates by country in 2019 per 100K were 

Jamaica = 2.3

Italy = 4.3

Israel = 5.2

UK = 6.9

Germany = 8.3

Ireland = 8.9

France = 9,7

Canada = 10.3

Australia = 11.3

Japan = 12.2

U.S. = 14.5

Russia = 21.6

The US has twice the rate of suicide as the UK and 3 times the rate of Italy.

Grief - The body dies but the spirit lives on in the stories we tell.

 

The body dies but the spirit lives on in the stories we tell about the values, opinions, beliefs, and practices of the body which has died.

I had a dream last night about my paternal grandmother who died when I was 21. My aunt, her daughter, complained to me that I had not visited her and that she missed seeing me. I defended myself by telling my aunt, "But I thought she died?" My aunt repeated her statement, "No, she is alive and well and wants to see you."

"Okay," I said, "I'm sorry. I guess I was mistaken. I will go and see her."

I did go to see her and apologized. I said to her, "Grandma, I thought you had died."

She said, "No, I've been here and I've missed you."

She was quite different in that she seemed very happy and enjoying her life and I was very happy to learn she was alive and I could visit her now. We had a delightful visit and I look forward to many more. It was a joy to reconnect.

Meditation and Aerobic exercise can reduce depression up to 40% in two months

 

Meditation and aerobic exercise together can help reduce depression, research finds. Targeting both the mind and the body — for twice a week over two months — was enough to reduce depression by 40 percent. #mentalhealth, https://t.co/5sE35N5CzW

— David Markham (@DavidMa03737241) June 20, 2022

What is success?

Success at age 3 is not peeing your pants or skirt,

Success  at age 16 is driving a car

Success at 18 if discovering the wonder and intimacy of sex.

Success in your 20's and 30s is finding a meaningful  job or profession and raising your kids at home.

Success in your fifties and 60's is getting your kids out of your home.

Success in your 60's and 70's is wondering if you really want to have sex.

Success in your 70's and 80's is keeping your drivers license.

Success in your 80's, is of course, not peeing your pants or skirt.

How has that been working for you?

Perhaps even more than professional background, the therapist’s theoretical approach to clinical practice is a decisive facet in defining a psychotherapist’s identity, 6 and those theoretical approaches are also very diverse. In the clinical literature there appear to be literally hundreds of theoretical orientations, often closely related to one another, and with labels differing just by a word or two, sometimes prompted by therapists’ desires to have their own “brand” in the marketplace.

Orlinsky, David E.. How Psychotherapists Live (p. 15). Taylor and Francis. Kindle Edition. 

When people ask me what kind of psychotherapist I am I say, “I am a practical therapist. I talk with people about what might help with the problems they are trying to manage and when they return for their next session I ask, ‘How has that been working for you?”

People laugh, and I laugh, and it’s all good.

What happened to continuity of care in mental health?

 As has long been observed (e.g., Henry, Sims & Spray, 1972; Holt, 1971; Orlinsky, 2009) there is no single, inclusive and comprehensive profession of psychotherapy. 2 This differs markedly from other established professions such as medicine and law, engineering and accounting, nursing and ministry, and so on. Instead, psychotherapy is practiced as a sub-specialty within several different professions, each of which itself follows no single pattern of practice guided by a generally accepted theoretical framework.

Orlinsky, David E.. How Psychotherapists Live (p. 14). Taylor and Francis. Kindle Edition. 

Psychotherapy is a subspeciality of several professions such as Psychiatry, Psychology, Social Work, Counseling, Nursing, Art Therapy, Music Therapy, Marriage and Family Therapy, Substance Abuse counseling, Occupational therapy, Acupuncture, Naturopathic medicine, etc.

This use of psychotherapy in many mental health professions is called “role diffusion.” Each mental health profession also bring different knowledge bases and skills which is called “role differentiation”. In agencies and health care organizations, mental health services are often provided by a “team.” A mental health team is composed of individuals from different professional disciplines.

In agencies and health care organizations where teams are used to provide services there often is a “primary therapist” assigned who oversees the comprehensive treatment plan and assures continuity of care. In the last few decades with the increasing reliance on revenue from health insurance to pay members of a mental health treatment team, the emphasis by administrators is on the provision of reimbursable procedures rather than patient care and this management system has fractured treatment teams and corrupted the continuity of care leading to poor patient care and demoralization of staff.

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.’