Forbes - Why It’s Time To Take A New Look At Psychoanalytic Psychotherapy

Echoing the classic Rodney Dangerfield line, psychoanalytic psychotherapy gets no respect. Considered the gold standard of treatment for much of the 20th-century, it was exiled to the desert when it did not live up to its own over-inflated claims. This method of treatment is now ignored by those not specifically studying it. And when it is mentioned, with some notable exceptions, it is often caricatured as a wasteful antediluvian method of treatment without empirical support rooted in discredited theories. But it may be time for this cultural neglect to end. Policy makers, health-care purchasers and individuals seeking care for problems in living might want to take a new look at psychoanalytic psychotherapy. In fact, I hope to convince you the time is right to bring it back from the desert.

As a practicing psychoanalyst for more than two decades who has also been in psychoanalytic treatment (twice as a matter of fact) I could approach the topic confessionally, from either side. But I won’t. After all, confessional anecdotes only go so far. Plus, I want to focus on several developments that support taking a new look.

One development making now an especially good time for the new look is the chaos roiling mental health-care delivery systems . There are provider shortages in the face of growing demand for mental health care. The TLA therapies (CBT, ACT, DBT, MBT, EFT, etc.) battle for supremacy against each other and medication to be the top of the line EBT (Empirically Based Therapy).  Meanwhile managed-care companies face lawsuits alleging duplicitous rationing of care for profit while op-ed pieces illustrate managed-care malfeasance. All this while tele-(mental)-heath and technologically-mediated treatments promise revolutions in care so far unrealized. With mental health-care in such a state of messy uncertainty there is really nothing to lose from reconsidering psychoanalytic psychotherapy, and much to gain.

But there are obstacles. A frequent canard used to justify ignoring psychoanalytic psychotherapy is that there is no research documenting its effectiveness. Simply put, this is false. That’s right, the “talking cure” works at least as well as anything else and probably better for some. While much more needs to be done, and needs to be done against a funding headwind focussed on medications and short-term approaches, there is a lot of specifically psychoanalytic research available.

For example, a 2013 randomized control trial demonstrated the efficacy of psychoanalytic psychotherapy for treating panic disorder. A 2010 meta-analytic review of available outcome studies showed that “empirical evidence supports the efficacy” of psychoanalytic psychotherapy. It further showed that the magnitude of change in psychoanalytic psychotherapy is “as large as those reported for other therapies that have been actively promoted as ‘empirically supported’ and ‘evidence based’.”

Because psychoanalytic psychotherapy adapts technique to the unique individuality of each patient, it can seem to some like all art and no science. “Where’s the manual!” goes the cry. The fact is that psychoanalytic psychotherapists typically rely on research to guide the moment-to-moment decisions of a clinical encounter, especially infant development research and increasingly neuroscience. If CBT, as a way to illustrate, can be thought of as someone expertly playing sheet music, psychoanalytic psychotherapy is more like well-structured improvisational jazz.

Another canard is that psychoanalysis is just a bunch of yadda-yadda-yadda, just talk. True, it is. But talk changes brains. In fact, a recent review of psychotherapy and brain function described three patterns of change in brain function: “psychotherapy results in either a normalisation of abnormal patterns of activity, the recruitment of additional areas which did not show altered activation prior to treatment, or a combination of the two.” More specifically, a neuro-imaging study of long term psychoanalytic psychotherapy with depressed patients documented clinically-relevant “neurobiological changes in circuits implicated in emotional reactivity and control” after the treatment was concluded.

Apparently, not only does it work but when psychoanalytic talking works, brains change.

Of course, psychoanalysis is not for everyone. Nothing is. It should be one treatment choice among many. One reason psychoanalysis is ignored today is because for much of the 20th-century it presented itself as the gold standard, even as a kind of universal appendectomygood for whatever it is that might be ailing anyone and everyone. Gladly, such therapeutic arrogance has largely left the field.

And there are other changes internal to psychoanalysis warranting a new look at this form of treatment. How treatment takes place has undergone a fundamental change since the mid-20th century psychoanalytic heyday. No longer does a psychoanalyst try to be a blank screen on which patients  project their experience where it can then be examined uncontaminated by the person of the analyst. Instead, psychoanalysts today recognize that, like every relationship, there are always two people present influencing each other in unique individual ways. There are no blank screens. The person of the analyst is always present in some way.  Rather than cultivating emotional absence, being a psychoanalyst requires a much more difficult radical acceptance of who one is and how one may or may not be influencing the treatment. Treatment is then a meeting of two people who are both always inevitably present. But, unlike other relationships, these two meet for the sole purpose of helping one of them explore and accept the patient’s history and possibilities, however painful, dirty, nasty, loving, glorious and even boring that person’s emotional truth may be.

So, if I’m not trafficking in the old Freudian caricatures of silent bearded white men purveying absurd  theories of secret sexuality, what is psychoanalytic psychotherapy? What actually happens in this treatment I think deserves a new look—and more respect? There are three parts:

One
It’s a method of treatment that works by helping people understand how they unconsciously create problematic patterns of thinking, feeling, acting, and relating.

Two
Unconsciously created problems (including the various problems in living that for purposes of diagnosis are called symptoms) usually recreate patterns, problems and solutions from early intimate relationships. Like never forgetting how to ride a bike, we never forget how we were first loved. Those relationship procedures remain. But by putting words to those implicit relationship procedures people become able to make freer choices and have new experiences.

Three
The moment to moment relationship between therapist and patient is a [pick your metaphor] laboratory/playground/theater for experiencing and understanding those early relationship procedures. Living through those moments together in the treatment allows for an immediate, non-abstract awareness. It is a deep knowing, one with transformative power.

In other words, psychoanalytic psychotherapy takes subjectivity seriously as an object of inquiry and a path to change. It starts simply with your unique experience of being you and creates conditions for a relationship to grow in which the multiple meanings of your experience are explored. And with the knowledge gained, a deep knowledge, comes freedom to make better choices.

For more mental health resources, Click Here to access the Serious Mental Illness Blog
Click Here to access original SMI Blog content

one of the things that bothers me about psychiatry is how it forces harmful treatments on people who don’t want them while it doesn’t even help the people who want voluntary psychiatric treatment.

let me explain. i have been an involuntary patient five times in the last year. the one time i wanted to be admitted to the hospital voluntarily because i was hearing the voice of satan and that’s terrifying, they turned me away and told me i was faking

they do the same thing with meds. getting prns form psych nurses is like pulling teeth. you can have a full-blown panic attack. you can be sobbing in a ball on the floor. they will tell you “you don’t need medication, you just need to breathe deeply”. well i guess they just must be really concerned about the effects of medication? unfortunately, no. when i was not violent, not suicidal, just hearing occasional voices, they held me down and gave me an injection, which traumatized me for life

finally, you will never be diagnosed with something if they think you want to be diagnosed with it. if you don’t want to be diagnosed with something? instant diagnosis. the fact that you don’t want to be diagnosed with it means you lack insight, which is proof of how sick you really are. but if you’ve done your research and actually feel like getting a diagnosis would be helpful in you life? you’re a self-diagnosing faker

the question is, why does psychiatry do this? the answer is simple:because they believe that they are the experts on us, and that we know nothing about ourselves and our experiences. everything we say is either a lie or invalid

there is an actual scale of insight that includes a statement that goes something like “my doctor knows better than me about my illness” and if you disagree with that statement, it means you lack insight

idk, idk, i know this very long and rant-y and might not be coherent. but i feel like this is very important and needs to be said

edit: this post is ok to reblog

How to Keep Calm!

1. Remind yourself that worrying doesn’t stop things happening. Things will happen – or not happen –anyway. Don’t forget to breath! :)

2. Recognise that “What ifs” don’t usually help with problem solving. It’s better to use logic, and brain storm for solutions. Take control of your emotions by using rational thinking. Take a step back, solve the problem.

3. Motivate yourself by something other than worrying. Take a break and do something fun, and then go back to your work again. That positive approach will reap more benefits. Play some rugby, or go to the gym, American football, whatever it is, just keep yourself busy but take a break from worrying.

4. Face your fears – and do the things that you worry about. The thought is often much worse than the actual thing you fear. It’s all in your head!

5. Ask yourself “What’s the worst thing that could happen?” Then, “What are the chances that it will happen? Then “Will you survive it, if it happens, in the end?”. Usually, that helps to move us from an extreme and irrational way of thinking to a more realistic, and reasonable way if thinking.

6. Teach yourself a range of relaxation strategies – and then concentrate on them instead of on your different fears. Or, adopt a mindful approach – and keep your focus on “right now”.

i feel a lot of psychiatrists don’t mention this crucial piece of information, so here it is: if you’re on a psychiatric medication (or other prescriptions meds), chances are you should NOT be eating grapefruit.  you should also be careful to not eat other citrus fruits in large quantities.

Grapefruit juice blocks special enzymes in the wall of the small intestine that actually destroys many medications and prevents their absorption into the body. Thus, smaller amounts of the drugs get into the body than are ingested. When the action of this enzyme is blocked, more of the drugs get into the body and the blood levels of these medications increase. This can lead to toxic side effects from the medications.

-medicinenet.com

the medications vary, but include especially psychiatric medications, and those mentioned here:

The list of medications that can interact with grapefruit is long and includes commonly prescribed medicines that fight infections, reduce cholesterol, treat high blood pressure and treat heart problems.

-mayo clinic

some more information from the cbc:

David Bailey, a clinical pharmacologist at the Lawson Health Research Institute in London, Ont., discovered the interaction between grapefruit and certain medications more than 20 years ago. Since then, he said, the number of drugs with the potential to interact has jumped to more than 85.

Of the 85 known drugs that interact with grapefruit, 43 can have serious side-effects, including sudden death, acute kidney failure, respiratory failure, gastrointestinal bleeding and bone marrow suppression in people with weakened immune systems.

The authors noted that all sources of grapefruit — the whole fruit or 200 mL of grapefruit juice — and other citrus fruit such as Seville oranges (often used in marmalade), limes and pomelos can lead to drug interactions.

-cbc

& lastly, nps has a non-complete list of medications that do interact with grapefruit, that link is here.

if you’re on medication, especially psychiatric medication, i highly recommend you google your specific drug to find out about grapefruit interactions, or phone your pharmacy and ask the pharmacists.

please feel free to reblog, unfortunately a lot of doctors don’t warn patients about the danger of grapefruit and i want people to be aware.

REALITY VS SOCIAL ANXIETY

I am a psychology student. We are conducting a project with social anxious people. We try to help these people. Of course this is not a therapy or something like that. We just want to make them more social persons. We have a schedule including drama, theater, dance activities. Also, we contact famous psychologists and psychiatrists to invite them our seminars. So that, anxious people can learn what social anxiety is and they find opportunities to improve their social relations.

We can talk social anxious people though our project. We try to undertand how they feel, we try to imagine how it feels like having social anxiety. And social anxiety feels like just these pictures. Answering a phone is easy for many of us, or ordering something. But they are like nightmares for social anxious people.

You should know that social anxiety is not unsolvable. Psychological therapy and medicines make you feel better, make you feel like you are alive.

At the same time, we keep trying to help them. Because it works! :)  

2

Shake it off? Not so easy for people with depression

Rejected by a person you like? Just “shake it off” and move on, as music star Taylor Swift says.

But while that might work for many people, it may not be so easy for those with untreated depression, a new brain study finds.

The pain of social rejection lasts longer for them — and their brain cells release less of a natural pain and stress-reducing chemical called natural opioids, researchers report in the journal Molecular Psychiatry.

The findings were made in depressed and non-depressed people using specialized brain-scanning technology and a simulated online dating scenario. The research sheds new light on how the brain’s pain-response mechanism, called the opioid system, differs in people with depression.

On the flip side, when someone they’re interested in likes them back, depressed people do feel relatively better — but only momentarily. This may also be explained by differences in their opioid system compared to non-depressed people, according to the new results.

Further research could lead to a better understanding of how to boost the opioid response in depressed individuals to reduce the exaggerated effect of social stress, and to increase the benefits of positive social interactions.

Natural painkillers

A team from the University of Michigan Medical School, Stony Brook University and the University of Illinois at Chicago worked together on the study, which builds on previous work about social rejection in non-depressed people.

“Every day we experience positive and negative social interactions. Our findings suggest that a depressed person’s ability to regulate emotions during these interactions is compromised, potentially because of an altered opioid system.  This may be one reason for depression’s tendency to linger or return, especially in a negative social environment,” says lead author David Hsu, Ph.D., formerly of U-M and now at Stony Brook. “This builds on our growing understanding that the brain’s opioid system may help an individual feel better after negative social interactions, and sustain good feelings after positive social interactions.”

The researchers focused on the mu-opioid receptor system in the brain – the same system that they have studied for years in relation to response to physical pain.  During physical pain, our brains release opioids to dampen pain signals.

The new work shows that this same system is associated with an individual’s ability to withstand social stress – and to positively respond to positive social interactions, says senior author Jon-Kar Zubieta, M.D., Ph.D.

“Social stressors are important factors that precipitate or worsen illnesses such as depression, anxiety and other neuropsychiatric conditions. This study examined mechanisms that are involved in the suppression of those stress responses,” he says. “The findings suggest novel potential targets for medication development that directly or indirectly target these circuits, and biological factors that affect variation between individuals in recovery from this otherwise chronic and disabling illness.” Zubieta is a member of U-M’s Molecular and Behavioral Neuroscience Institute and the U-M Depression Center, and is the Phil F. Jenkins Research Professor of Depression in the Department of Psychiatry.

The new findings have already prompted the team to plan follow-up studies to test individuals who are more sensitive to social stress and vulnerable to disorders such as social anxiety and depression, and to test ways of boosting the opioid response.

“Of course, everyone responds differently to their social environment,” says Hsu. “To help us understand who is most affected by social stressors, we’re planning to investigate the influence of genes, personality, and the environment on the brain’s ability to release opioids during rejection and acceptance.”

Scanning the brain – and finding surprises

The research used an imaging technique called positron emission tomography, or PET. U-M has a PET scanner devoted to research – and a particle accelerator to make the short-lived radioactive elements that enable PET scans to track specific brain activity. The depressed individuals all met criteria for major depressive disorder, and none was taking medication for the condition.

Before having their brains scanned, the 17 depressed participants and 18 similar but non-depressed participants each viewed photos and profiles of hundreds of other adults. Each person selected profiles of people they were most interested in romantically – similar to online dating.

During the brain scan, participants were informed that the individuals they found attractive and interesting were not interested in them. PET scans made during these moments of rejection showed both the amount and location of opioid release, measured by looking at the availability of mu-opioid receptors on brain cells. The depressed individuals showed reduced opioid release in brain regions regulating stress, mood and motivation.

During social acceptance when participants were informed that people liked them back, both depressed and non-depressed individuals reported feeling happy and accepted. This surprised the researchers, says Hsu, because depression’s symptoms often include a dulled response to positive events that should be enjoyable.  However, the positive feeling in depressed individuals disappeared quickly after the period of social acceptance had ended, and may be related to altered opioid responses.

But only non-depressed people went on to report feeling motivated to connect socially with other people. That feeling was accompanied by the release of opioids in a brain area called the nucleus accumbens — a structure involved in reward and positive emotions.

The researchers had actually informed participants ahead of time that the “dating” profiles were not real, and neither was the “rejection” or “acceptance.” Nonetheless, the simulated online dating scenario was enough to cause both an emotional and opioid response. Before the end of the visit, staff gave depressed participants information on treatment resources.

"We enrolled almost all of these subjects in a subsequent treatment study – which allows us to capture additional information about how these opioid changes to acceptance and rejection may relate to success or failure of our standard treatments" says study co-investigator Scott Langenecker, formerly at U-M and now at the University of Illinois at Chicago.

He adds, “We expect work of this type to highlight different subtypes of depression, where distinct brain systems may be affected in different ways, requiring us to measure and target these networks by developing new and innovative treatments.”

Reference: Molecular Psychiatry (2015) 20, 193–200; doi:10.1038/mp.2014.185

2

My therapist gave me a list of fun activities to bring joy back into my life. Seriously. Read this shit. It has such gems as losing weight, rearranging the furniture and saying I love you.It even has relaxing listed as a fun activity.

Here’s the deal. Its not like depressed people don’t want to do things we enjoy. Its the things no longer bring us any happiness. I wish they did.

gofunyourselflist.tumblr.com to see me tick off every damn thing on this list and log whether it actually helped.