The Therapeutic Alliance: The Essential Ingredient for Psychotherapy

 I am currently writing on the ‘therapeutic alliance’ – its relation to mindfulness, psychotherapy, understanding, and ‘being listened to…’   What follows is an interesting article that I came across that may interest some of you…

Excerpt:

Have you ever tried to change the way you do something? It could be anything — the way you hold your tennis racket, blow into a flute, meditate — you name it. If so, think about that experience. No matter how motivated you were to change, and no matter how much you knew that it would help your serve, musicality, or sense of inner peace, it can be difficult and scary to change even the smallest thing. In order to change, you have to give up your old way of doing something first and then try the new way. That means that for a while you’re in a free fall — you no longer have your old habit to rely on and you don’t yet have the new one.

The anxiety of trying to change something as complex and entrenched as how you relate to people close to you or manage stress takes the feeling to a whole new level. Yet, that’s just what you do when you enter psychotherapy. Just as you had to put yourself into the hand of your teachers and coaches, in therapy you need to gradually do just that with your therapist to help you through what can be a harrowing adventure. The foundation for therapy is called the therapeutic alliance (1, 2). When it’s there, you know that your therapist is there to help you, no matter how hard the going gets.

The therapeutic alliance might be the most important part of beginning a psychotherapy. In fact, many studies indicate that the therapeutic alliance is the best predictor of treatment outcome (3-5).

See entire article:

http://www.huffingtonpost.com/deborah-l-cabaniss-md/therapeutic-alliance_b_1554007.html

 

A mad world A diagnosis of mental illness is more common than ever – did psychiatrists create the problem, or just recognise it?

When a psychiatrist meets people at a party and reveals what he or she does for a living, two responses are typical. People either say, ‘I’d better be careful what I say around you,’ and then clam up, or they say, ‘I could talk to you for hours,’ and then launch into a litany of complaints and diagnostic questions, usually about one or another family member, in-law, co-worker, or other acquaintance. It seems that people are quick to acknowledge the ubiquity of those who might benefit from a psychiatrist’s attention, while expressing a deep reluctance ever to seek it out themselves…

…While a continuous view of mental illness probably reflects underlying reality, it inevitably results in grey areas where ‘caseness’ (whether someone does or does not have a mental disorder) must be decided based on judgment calls made by experienced clinicians. In psychiatry, those calls usually depend on whether a patient’s complaints are associated with significant distress or impaired functioning. Unlike medical disorders where morbidity is often determined by physical limitations or the threat of impending death, the distress and disruption of social functioning associated with mental illness can be fairly subjective. Even those on the softer, less severe end of the mental illness spectrum can experience considerable suffering and impairment. For example, someone with mild depression might not be on the verge of suicide, but could really be struggling with work due to anxiety and poor concentration. Many people might experience sub-clinical conditions that fall short of the threshold for a mental disorder, but still might benefit from intervention.

See link for interesting article on psychiatry…and bits about the importance of psychotherapeutic intervention…

http://aeon.co/magazine/being-human/have-psychiatrists-lost-perspective-on-mental-illness/

Schizophrenia and Poverty, Crime and Violence

EXPLORINGtheLATERAL

Schizophrenia and Poverty, Crime and Violence

For people who have schizophrenia, and don’t get treatment, the result is far too often that they end up homeless or in jail (most often due to minor offenses). Approximately 200,000 individuals with schizophrenia or manic-depressive (bipolar disorder) illness are homeless, constituting one-third of the approximately 600,000 homeless population (total homeless population statistic based on data from Department of Health and Human Services). These 200,000 individuals comprise more than the entire population of many U.S. cities, such as Hartford, Connecticut; Charleston, South Carolina; Reno, Nevada; Boise, Idaho; Scottsdale, Arizona; Orlando, Florida; Winston Salem, North Carolina; Ann Arbor, Michigan; Abilene, Texas or Topeka, Kansas. At any given time, there are more people with untreated severe psychiatric illnesses living on America’s streets than are receiving care in hospitals. Approximately 90,000 individuals with schizophrenia or manic-depressive illness are in hospitals receiving treatment for their disease. Source: Treatment…

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When Ignorance Begets Confidence

“There are few people whom I really love, and still fewer of whom I think well. The more I see of the world, the more am I dissatisfied with it; and every day confirms my belief of the inconsistency of all human characters, and of the little dependence that can be placed on the appearance of either merit or sense.” _{— Pride and Prejudice by Jane Austen}

I begin with this quote to convey the feelings evoked in a recent exchange with a neighbor, one in which surprise (and some horror) was felt during the course of the conversation.  Logic and ‘reasonableness’ had little place in the interchange. I had just been reading a short article that looked at particular German words that gave expression to complex emotional states. An excerpt is as follows: 

“Fremdschämen describes embarrassment which is experienced in response to someone else’s actions, but it is markedly different from simply being embarrassed for someone else….Fremdscham (the noun) describes the almost-horror you feel when you notice that somebody is oblivious to how embarrassing they truly are.” Further…”Fremdscham-inducing events…usually cause one to ask this question: “how on earth can these people be unaware of how stupid they are being right now?”.

I invite you to read this short article on the cognitive bias created in the Dunning Kruger effect – an effect that causes one to be unaware of their performance – and their incompetence.

http://www.psychologytoday.com/blog/evolved-primate/201006/when-ignorance-begets-confidence-the-classic-dunning-kruger-effect?fb_action_ids=10202209567024712&fb_action_types=og.likes&fb_source=other_multiline&action_object_map=%7B%2210202209567024712%22%3A483617186047%7D&action_type_map=%7B%2210202209567024712%22%3A%22og.likes%22%7D&action_ref_map=%5B%5D

Related articles

• Dunning Kruger Effect (matznerd.com)

“The Red Book”: A Primer For Healing Madness In A Mad World

“Naturally I compensated my inner insecurity by an outward show of security, or — to put it better — the defect compensated itself without the intervention of my will. That is, I found myself being guilty and at the same time wishing to be innocent. Somewhere deep in the background I always knew that I was two persons. One was the son of my parents who went to school and was less intelligent, attentive, hard-working, decent, and clean than many other boys. The other was grown up — old, in fact — skeptical, mistrustful, remote from the world of men, but close to nature, the earth, the sun, the moon, the weather, all living creatures, and above all close to the night, to dreams, and to whatever “God” worked directly in him.” (p. 44, The Red Book by Carl Jung)

“On the contrary, it is played out in every individual. In my life No. 2 has been of prime importance, and I have always tried to make room for anything that wanted to come from within. He is a typical figure, but he is perceived only by the very few. Most people’s conscious understanding is not sufficient to realize that he is also what they are.” (p. 45, The Red Book by Carl Jung)

Laura K. Kerr, Ph.D. wrote an incredible blog post about The Red Book by Carl Jung, read the rest of the article. . . on her blog, Trauma’s Labyrinth.

Related articles

• CG Jung And The ‘Leap Of Faith’ Into Individuation (beyondmeds.com)
• CG Jung And The ‘Leap Of Faith’ Into Individuation (scottfree2b.wordpress.com)
• Fantasy [the basis of Active Imagination] in Psychological Types and The Red Book: (carljungdepthpsychology.blogspot.com)
• Madness (minnieeve.wordpress.com)

Freud’s theoretical formulations were not rigidly fixed, but set down instead as formulations that could change…allowing more emphasis on ‘not knowing.’

Review of Attachment and Psychoanalysis – published this week.  (see link below)

Attachment and Psychoanalysis
Theory, Research, and Clinical Implications
by Morris N. Eagle
Guilford Press, 2013

http://metapsychology.mentalhelp.net/poc/view_doc.php?type=book&id=6971&cn=395

Related articles

• Creative Art Therapy and Attachment Work (psychologytoday.com)
• The enduring legacy of Freud – Anna Freud (bbc.co.uk)

Inspiration: Movies about mental illnesses

– submitted by Ruth Levine, MD, University of Texas Medical Branch, Galveston

Brilliant psychological movie. Dissociation?

 

Anxiety and Anxiety Disorders	Bipolar Disorder/Mania
Copycat (panic/agoraphobia)	Mr. Jones
As good as it gets (OCD)	Network
The touching tree (Childhood OCD)	Seven Percent Solution
Fourth of July (PTSD)	Captain Newman, MD
The Deer Hunter (PTSD)	Sophieís Choice
Ordinary People (PTSD)	Sheís So Lovely
Depression	Psychosis
Ordinary People	Shine
Faithful	I Never Promised You a Rose Garden
The Seventh Veil	Clean Shaven
The Shrike	Through a Glass Darkly
Itís a Wonderful Life (Adjustment disorder)	An Angel at my Table
The Wrong Man (Adjustment disorder)	Personal
Dissociative Disorders	Man Facing Southwest
The Three Faces of Eve	Madness of King George (Psychosis due to Porphyria)
Sybil	Conspiracy Theory
Delirium
The Singing Detective
Substance Abuse
The Long Weekend (etoh)	The Days of Wine and Roses (etoh)
Barfly (etoh)	Basketball Diaries (opiates)
Kids (hallucinogens, rave scenes, etc.)	Loosing Isaiah (crack)
Reefer Madness	Under the Volcano
Long Day’s Journey into Night	Ironweed
The Man with the Golden Arm (heroin)	A Hatful of Rain (heroin)
Synanon (drug treatment)	The Boost (cocaine)
The 7 Percent Solution (cocaine induced mania)	Iím Dancing as Fast as I can (substance induced organic mental disorder)
Eating Disorders
The Best Little Girl in the World (made for TV)-Anorexia	Kateís Secret (made for TV)-Bulemia

Axis II Disorders

Personality Pathology
Cluster A	Cluster B
Remains of the Day- Schizoid PD	Borderline PD
Taxi Driver-Schizotypal PD	Fatal Attraction
The Caine Mutiny- Paranoid PD	Play Misty for Me
The Treasure of Sierra Madre -Paranoid PD	Frances
	After Hours
Cluster C	Looking for Mr. Goodbar
Zelig-Avoidant PD
Sophieís Choice-Dependent PD	Histrionic PD
The Odd Couple-OCPD	Bullets over Broadway
	Gone with the Wind
	A Streetcare Named Desire
	Antisocial PD
	A Clockwork Orange
Narcissism	Obsession
All that Jazz	Taxi Driver
Stardust Memories	Single White Female
Zelig	The King of Comedy
Jerry Maguire	Triumph of Will
Alfie
Shampoo	Mental Retardation
American Gigolo	Charly
Citizen Kane	Best Boy
Lawrence of Arabia	Bill
Patton	Bill, On His Own

Miscellaneous Issues

Family	Early Adult Issues
Ordinary People	Awakenings
The Field	The Graduate
Kramer vs Kramer	Spanking the Monkey
Diary of a Mad Housewife
Betrayal	Latency and Adolescent Issues
Whoís Afraid of Virginia Woolfe	Stand by Me
The Stone Boy	Smooth Talk
The Great Santini
Doctor/Patient Relationship	Boundary Violations
The Doctor	The Prince of Tides
	Mr. Jones
Idealized “Dr. Marvelous” Psychotherapy
Spellbound	Suddenly Last Summer
The Snake Pit	Captain Newman, MD
The Three Faces of Eve	Ordinary People
Good Will Hunting

Steve Hyler directs an APA course on this topic, and
would be a good person to check with.
For more details, you can call me (409) 747-1351. Hope to see you in Maine!

–Ruth Levine
University of Texas Medical Branch

---

| Back to the ADMSEP Resources Page |

I am not bipolar, I have it.

I am not Bipolar.  I have Bipolar.  It is not me, and I live with it, but I do not allow it to have me.

I know, this is all quibbling with language, but when we use language to think, to define ourselves and who we are, our words and their meanings become vital.  All to often, people are classified, or classify themselves as “Bipolar”, as if it were a nationality, culture, heritage or something that defines who we are.

I refuse.

Cancer patients don’t call themselves,”Cancerous”, although Cancer decides much of what they do and how they live.  They have Cancer.  Some lie down and allow their lives to go the way they go.  Some fight tooth and nail.  Some ignore it completely, living with it to the end.  There may be an exception somewhere to this, but I haven’t met anyone who said,”I am cancerous.”  They have it.

So, that’s my attitude.  It’s not for everyone, and if you are a “Bipolar” and embrace it, then good for you.  It’s not for me.

How do I fight?

First of all, I take the position that, despite the way my decision making abilities are tied to my emotion and energy and the way that they don’t always make any rational sense, I am the decision maker here.  If I choose to start behaving in a way that is a danger to myself or someone else, I made that choice.  I own it.  It may have been a poor choice, and may have been helped along by having Bipolar, but I made the decision to do X.  No one made me do it but me.

This position has it’s good and bad points.  It allows me to claim control over something, when internally it’s as if I’m mostly an observer.  Society appears to be all in favor of me lying down and claiming,”But, I’m bipolar, and I am out of control.”  I don’t want that.  I am 36 years old.  I’m a father, and if one of my kids says,”I was out of control”, as a parent, I still punish them for acting badly.  I have more control than a 4 or 8 or 12 year old, even if that control extends only to,”This is getting too hard, I need help.”  It allows me to live and be productive and helpful and a positive influence on my friends and family.  It makes me “happy”.

Secondly, I pay attention.  I pay a LOT of attention to what is going on with me internally.  For example:  Right now, I am a tad stressed, but not bad.  I’m on an “upswing” towards a potential hypo or hyper manic phase, but I won’t know how far it will go until I get there, but I know it bears careful attention to my sleeping patterns and closer scrutiny of decision making.  My chest has that odd “excitement/panic/fear/happiness” tingle to it.  My muscles are “sparkly” as I describe it, that sensation of when the adrenalin is about to drop into your system before a competitive race or something.  My thoughts are quick, but not racing, yet.  This all means that my patience is less, my temper is shorter, and I should probably not make any major decisions on my own and without reflection right now.

I know what I need to do, and the decision is mine as to whether to do the things that will allow me to continue to live and be a “good” influence on those around me or not.

Third, I try to focus my energy on things that are intangible , if I have an excess.  If I am manic and not sleeping, I will try to make myself consider philosophical thoughts, and if possible, engage someone in discussion.  Maybe I’ll pay attention to a social issue, and research it until I feel that I can come to a reasonable conclusion.  Maybe I’ll work on some creative writing.  I know that, me being me, I should try to avoid people that might take advantage of my heightened energy and such until it calms down.

I know what you may be thinking,”That’s not what so many other people say/think/write”.  Nope.  It’s not.  This is what works for me and how I think.

Should Bipolar be fought against or embraced?  I think that’s a decision each of us has to make on our own.  To me, embracing bipolar means “riding the roller coaster”, or more accurately, trying to form my life to where the roller coaster takes me.  If it were just me that I was responsible for, this might be a reasonable choice for me, but other people are effected by everything I say and do.  I choose to accept this responsibility to those people I love and care about and try to set aside my own feelings as I can.

Sometimes, it gets to be too much, and I have to tell everyone that I must take a break.  They can react how they like, but sometimes I have to tell the rest of the world that, for a little while, they can all go hang, or they will be without my influence.  This is a complication to the way I deal with life that the average “boss” will not accept or understand, and that’s ok.  I live within the means that I am able to create for myself or have access to.

I am an individual.  I am not Bipolar, I have it.  It does not define me, that is something I choose.  I do not fit into the “bipolar” category.  I don’t think that anyone really does.  Sometimes I am up so high that the world seems distant and beside the point.  Sometimes I’m so low that the world is monster threatening to destroy me.  It is not those times where I can do this stuff on my own.

So, I work on it.  I think through things, to the point that I research and plan things to the point of it being ridiculous at times.  My thought process is slow and complex, as I sort through information and determine the importance of it in order to come to a decision.  The way I do things internally doesn’t work out very well if I choose to follow an unplanned impulse.  I don’t do well in oral conversation, not having time to think about what I’m trying to say or having an easy way to rewind what has been said and make sure that my own impressions are accurate.  It allows me to live, though, and I’m used to it now.

There have been times I was in a hospital because, well, that’s where the rollercoaster had taken me.  I rode the rollercoaster into a dark, seemingly unending depression, or a manic phase dotted with delusions and hallucinations, or worse, into some bizarre mix of hyperactivity and depression, or a complete lack of energy and a nice dose of racing thoughts and grand ideas that, while grand, were impossible.

It has not been an easy road.  I did not get to this point at the flip of a switch or by taking a magic pill.  I have been fighting for 20 years since my first episode.  Therapy, meds of various kinds, and lots and lots of internal work and thought and reflection.

I know that it only takes a small slip to wind up back in a hospital, so I am careful.  If I see that I am on the way “up” or “down” or otherwise entering a realm where my decisions may not be the greatest, I try to act ahead of time, talking to people who will help me to make good decisions and good choices that allow me to continue.  If the help I get in “public” is not enough, then I may seek something more intensive, but I avoid that option if possible.

I am not bipolar.  I have it.  It does not define me.  I do that.  This is my mantra.  Every day that I wake up and lead a relatively normal appearing existence is a success.  Every day that I wake up and simply live, exist, function enough to get things done that make others’ lives easier is a success.  The only failure, for me, is to board the rollercoaster and raise my hands and let life happen to me.

Will it work for you?  That’s up to you.  Do I think anyone else should or should not choose to fight and live as I do?  No.  That’s up to you and your life and situation.  This is mine though.

It’s my life.  Because I am not bipolar.  I am me.  I am an individual.  I can not be defined as bipolar any more than I can define you as bipolar.  Who you are is your choice.  It may be the only choice you get to make, so make the choice that will make you happy and that will allow you to live as well as possible.

But, I define myself, and I am not bipolar.  I have it.

Bipolar, Schizophrenia Share Similar Emotional Perception Difficulties

By TRACI PEDERSEN Associate News Editor
Reviewed by John M. Grohol, Psy.D. on February 9, 2013

Although less severe, patients with bipolar disorder share many of the same cognitive difficulties as patients with schizophrenia — including problems with identifying facial expressions, emotions and facial gender, according to a new study.

Past research has shown that people with schizophrenia have clear cognitive deficits with respect to emotional perception.

Individuals with bipolar share many of the same genetic and environmental risk factors as those with schizophrenia, yet it has been unclear whether or not they share the same functional impairments.

To investigate this further, Jonathan K. Wynn, recently conducted a study which included 30 patients with schizophrenia, 57 with bipolar, and 30 with no history of any mental health problem.

About half of the participants with bipolar were on antipsychoticmedication during the study. Wynn showed the participants pictures of faces displaying emotions of fear, sadness, happiness, anger, or disgust.

He then had had them look at neutral facial expressions. The participants were instructed to identify the emotion on the first experiment and the gender of the face on the second experiment.

The patients with schizophrenia had the hardest time correctly identifying the facial expressions. The participants with bipolar identified the emotions more accurately, but took much longer to do so. And when they did, their scores were still much lower than the control group’s results.

When Wynn evaluated gender recognition abilities, he found again that both bipolar and schizophrenic patients had problems recognizing facial gender. These results were similar for both the bipolar patients who were taking medication and those who were not.

“Schizophrenia patients show deficits at multiple stages of facial affect processing whereas the deficits in bipolar disorder seem to be less severe and appear at the later stage of affect decoding,” said Wynn.

Despite those differences, the study clearly shows that people with bipolar can face challenges in social settings due to delays and impairments in cognitive processing.

Source:  Psychological Medicine

You may also like:

Link Between Schizophrenia, Bipolar Illness and Autism?

 

 

Schizophrenia Patients Often Mistake Angry Expression for Fear

Showing Signs Of Schizophrenia & Bipolar?Ask the Therapist

 

Social Cues Are Difficult for People with Schizophrenia

Adasuve Inhalant Approved for Agitation in Bipolar, Schizophrenia

Should I See a Specialist?Ask the Therapist

APA Reference
Pedersen, T. (2013). Bipolar, Schizophrenia Share Similar Emotional Perception Difficulties. Psych Central. Retrieved on July 24, 2013, from http://psychcentral.com/news/2013/02/09/bipolar-schizophrenia-share-similar-emotional-perception-difficulties/51409.html

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College Students Speak about Mental Illness

College Students Speak About Mental Illness: VIDEO

By RICHARD ZWOLINSKI, LMHC, CASAC & C.R. ZWOLINSKI

 

College classes begin in five or six weeks. How do you prepare for college if you have a mental illness?

These brave and articulate Leeds University students share their experience of coping with mental illness during their college years.

 

 

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• Eliminating the Stigma of Mental Illness (pittsburgh.cbslocal.com)