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

 

WOOLF’S DARKNESS: EMBRACING THE INEXPLICABLE

Woolf gave us limitlessness, impossible to grasp, urgent to embrace, as fluid as water, as endless as desire, a compass by which to get lost.

“The future is dark, which is the best thing the future can be, I think,” Virginia Woolf wrote in her journal on January 18, 1915, when she was almost thirty-three years old and the First World War was beginning to turn into catastrophic slaughter on an unprecedented scale that would continue for years. Belgium was occupied, the continent was at war, many of the European nations were also invading other places around the world, the Panama Canal had just opened, the U.S. economy was in terrible shape, twenty-nine thousand people had just died in an Italian earthquake, Zeppelins were about to attack Great Yarmouth, launching the age of aerial bombing against civilians, and the Germans were just weeks away from using poison gas for the first time on the Western Front. Woolf, however, might have been writing about her own future rather than the world’s…

…Despair is a form of certainty, certainty that the future will be a lot like the present or will decline from it; despair is a confident memory of the future, in Gonzalez’s resonant phrase. Optimism is similarly confident about what will happen. Both are grounds for not acting. Hope can be the knowledge that we don’t have that memory and that reality doesn’t necessarily match our plans; hope like creative ability can come from what the Romantic poet John Keats called Negative Capability.

On a midwinter’s night in 1817, a little over a century before Woolf’s journal entry on darkness, the poet John Keats walked home talking with some friends and as he wrote in a celebrated letter describing that walk, “several things dove-tailed in my mind, and at once it struck me what quality went to form a Man of Achievement, especially in Literature.… I mean Negative Capability, that is, when a man is capable of being in uncertainties, mysteries, doubts, without any irritable reaching after fact and reason.”

To read this entire essay, see link: http://www.newyorker.com/online/blogs/books/2014/04/virginia-woolf-darkness-embracing-the-inexplicable.html?utm_source=tny&utm_campaign=generalsocial&utm_medium=tumblr&mbid=social_tumblr

Depression and learning disabilities: Will you ever read anything like it?

“Stories are the foundation of identity. We forge meaning and build identity.”

Andrew Solomon

I am moving my eyes back and forth as I chase the words of enlightenment in Solomon`s book. Sometimes I glance up, look out the window and stare at moving cars or people. I let my feelings, awakened from a line beautifully crafted, circulate inside. I let the meaning of it touch me, and let the aftershock of new insights and hope explode. I want to inspire. I want to live.

The power of books, and the people writing them, can never be unappreciated. Instead of learning every lesson ourselves, we can let other words touch us by reading and listening to other`s experiences. The last week, I have either let my eyes rest on «The Noonday demon» or listened to “Far From the Tree “. Andrew`s two books feed you with experiences and knowledge from the first to the last page. The first digs deep into Andrew`s personal depressive demons, the other explores learning disabilities and challenging diagnoses like autism, schizophrenia and down`s syndrome.

Both books have a plethora of examples fitting the themes like a glove. They both blow life into theory, by letting us feel the people`s pain so we can also feel it. As psychological theories shows, you learn more when emotional. Another thing I like, is that my eyes never bumped into walls of bad writing, you simply float from page to page, only irritated by lack of time to devour everything at the same time (I have wished many times that I`d taken more time to learn to read faster, like I tried for a while).  

In addition to relevant stories from people with different types of problems, he writes about the newest research and even test many of the methods himself. He is not afraid of testing even alternative approaches that hasn`t been researched much. This is done in a balanced way since he manages natural skepticism blended with openness for new experiences at the same time (he liked EMDR).

I`m not sure how much time he`s used on the books, but I do know he`s been travelling all around the world (Bali, Africa, Europe and of course many states in USA) and investigated both medical and theoretical theories by reading and talking with professionals with diverse thoughts. He even tried to talk with America politicians (who sadly had their hand tied). It is clear he has taken the time necessary to write the book, even if he had to stop writing when Mr. depression knocked on the door.

Far From The Tree: Parents, Children and the Search for Identity by Solomon, Andrew (Feb 7, 2013)

Another positive feature of the book, is the compassion towards people with a variety of conditions most of us would automatically turn our backs too. He is honest while describing his thoughts and experiences, and doesn`t try to walk on the water with the work he`s done. He has a down to earth attitude, also when it comes to the description of own shortcomings. He writes he can feel self-absorbed at times, and tries to look own motives in the eye if they walk next to him. Acceptance is mixed with curiosity, and the end-product is two of the best books I`ve read this year. He talks about the magnificent courage of the interviewees, but seldom points to his own. If he mentions it, he talks about how he should have written more.

I must not forget to mention how much knowledge he has managed to fit in between the stories of people who fight every day. He is capable of doing this in a very readable way. The emotions awakened after stories, make it easier to remember the facts.

He presents a cocktail of different treatment options, and is not judgmental if others chooses something different than himself. Once in the book he states that people can use the strategy they want, as long as it helps. This shows more than anything, that he writes (among other reasons) to help others who suffer.

What touches me the most is his own insight about why he writes; Because it gives hope. He chose the stories of people who impressed him, which doesn`t mean that you won`t see the dark sides of depression or learning disabilities, because you will. It just means that he again uses his ability to balance different views with grace and style. In my opinion, if others find it too positive, this is one of the books qualities. We learn better if we realize that we can do something about it. That`s why they have anti-smoking advice on the cigarette packages. You can`t jump into the water if you don`t know how to swim. I could have written much more, but I`d rather just recommend it, and hope that people with interest in psychology and especially in depression or learning disabilities, will run to the next shop (or amazon internet store) and start their own trip to wonderland. 

• Author of The Noonday Demon: An Atlas of Depression, winner of the 2001 National Book Award. http://www.farfromthetree.com/

  buy the book here: Far From The Tree: Parents, Children and the Search for Identity by Solomon, Andrew (Feb 7, 2013)

  Andrew Solomon Supports Teen Writing Contest About Ment

  Andrew Solomon | TED Blog

  other blog entries:

  • The kind cat jumps out of its sack 
  • Looking for a writer

  Donation

  Scenes from the Empty Classroom

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/

Does abuse define a career path?

March 27, 2014 · therapy, trauma, work. ·

DEPRESSION

Does abuse define a career path?

BY DR. NICHOLAS JENNER ON MARCH 26, 2014 • ( 3 COMMENTS )

One of the enduring questions of human development and behaviour is why we take the paths that we do. What influences us in our choice of partner, profession, lifestyle and other things that make us who we are? This is a deep and complicated question even if a “good enough” upbringinghas been experienced but even more so when a history of abuse and/or dysfunctional parenting has prevailed. In this case, whenlackingthe foundation of security, how do abused children make their way in the world, seemingly dragging a ball and chain with them? A book I recently reviewed may offer some clues and answers to this.The book in question is  “Strong at Broken Places” by Linda TSandford.The basis of the book are the stories of twenty child abuse survivors who figured that “the best revenge is living well”. Prevailing over a childhood of sexual and physical abuse, neglect, parental substance abuse and witnessing domestic violence, Linda Sanford asked them to look back and help us all understand how they fared so well. One of the first popular books on resiliency, Strong at the Broken Placeswas written for every survivor, friend, family member, mentor or helping professional who seeks the path towards self-forgiveness and healing. 

Linda T Sandford spent most of time while writing her book explaining why she believes that abuse does not necessarily jump generations and the patterns of the past can be broken by survivors. This is often not the case when survivors of abuse choose a career path. It can be said that some abuse victims find their way in the working world because of the abuse and not in spite of it. Sandford eloquently uses a quote from Freud to start her reasoning: “there are two pillars of healthy life, love and work” It appears from Sandford’s research that many who could not find love, threw themselves into the other, making work the focus of their life.

In a normal family, parents are considerate and understanding with their children. They allow a child to be happy, responsible, creative and love is given and accepted by both sides. The child does not need to prove anything or work hard for the parent to love them and love is unconditional. In troubled families, abusive parents expect children to “do” for them in a spirit of “you are not good enough to love, you have to earn it”. Children, often thinking that this conditional love is better than none, “do” for their parents, becoming little “mothers, fathers, husbands or wives”.  This lead Sandford to the following conclusion: in contrast to the stereotype painted by society that abuse victims are “underachievers”, many excel at work, maybe because this work ethic is instilled in them through the abuse itself. This success in the workplace is usually not turned into the self-esteem that one would imagine. Many survivors point to the fact that work gives them a place “to belong”, either mirroring early family life helping siblings or parents or giving them something that they had never experienced before. Sandford states clearly that for many abuse victims, work is a manifestation of her theory of “looking good on the outside”.

It is then not surprising that abuse survivors often choose careers that have some relation to the abuse they suffered. Concerning this point, there is a widely held prejudice that due to the abuse, abuse victims careers are somewhat chosen for them through the conditioning experienced by the abusive parent. For example, if an abused child finds comfort in the animals or plants, many believe that this would drive them to be vets or horticulturalists. Sandford’s research did find, however, that many abuse victims end up in the helping professions, ranging from nurses to therapists. Through abuse and neglect, many survivors had to take on responsibility for the care of siblings and indeed parents from a young age and also have an ability to anticipate inappropriate behavior. Characteristics needed in abundance when helping others.

Found on fbcdn-sphotos-a.akamaihd.net

Jen • 1 year ago

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For many survivors, the world of work is a meaningful place. Many abuse victims were brought up in poverty and working hard is a way of providing financial security. Many of the sample interviewed were self-employed in some way to avoid working “for” someone and many saw work as a way “offering social contact but without the need to show vulnerabilities or bare one’s soul”. Many survivors were by their own admission, workaholics, stating that this addiction was “more socially acceptable” and is “rewarded by society” bringing a sense of “self worth” to what they are doing. Sandford states clearly that balance in life is vital. What worked as a child, that is working hard to achieve, rarely works as an adult and many survivors use this “busyness” as a shield for depression. Sandford finishes by saying that she believes that “being should stand proudly next to doing and working”.

Dr. Nicholas Jenner is a Counseling psychologist in private practice working with individuals, couples,  groups and companies globally. Online therapy is, in my experience, effective for treating a number of major conditions. Are you having issues that you need to talk through? I have a range of plans that can help you get the help you need.  Online Therapy details : Here ……

How would you like to be met?

Mental health and psychological problems are still stigmatized, even if 50 % of us will quality for some disorder once in our lifetime. The stigma can be explained many ways. Sometimes, people don`t know enough about psychology, but even people who`ve read a lot, can have prejudices. I have prejudices and problems with understanding, too, but I try to be aware of it.

Have you heard stories about people with psychological issues who weren`t believed or felt ridiculed if they tried to explain what they felt? Unfortunately, I have, and it scares me more than anything. I might even have acted differently myself, because we show dislike or contempt in many ways (and you don`t always notice it yourself). When busy, I must confess that I have a tendency to not meet the eyes of a beggar, and I have stepped back when I`m approached by for example an alcoholic.

When I do, I remember to watch myself from above, and take a deep breath. Usually, it helps, and I have learnt so much that way.

To illustrate what I mean by prejudice, I`ve included some pretty explanatory pictures.

 

 

Bloggen

• The pictures come from this good (norwegian) blog
• Other good blogs

Happy Heart – Healthy Heart

Panel Discussion

Earlier this week, Circulation, an online journal published the newest findings of a 12-person panel of experts who went on record determining that depression should be listed as a risk for heart disease along with already known risk factors such as obesity, smoking, high blood pressure and diabetes.

The recommendation was made to the American Heart Association (AHA), after Robert M. Carney, PhD, and Kenneth E. Freedland, PhD, both professors of psychiatry at Washington University School of Medicine in St. Louis and ten other experts in the field performed an extensive review of hundreds of studies in the scientific literature that looked specifically at correlating depression and heart attacks and eventual death from heart disease.

Depression

Doctors Caney and Freeland have been studying the effects of depression on heart disease for more than 25 years when they reported the increased risk of more severe cardiac problems in patients with pre-existing heart disease, who also were diagnosed with depression. A very high percentage of all the studies they conducted since beginning in 1988, support their findings that depression is a risk factor for death in people with heart disease.

Unlike definitive findings that are found when obese people lose a significant amount of weight in a healthy way, or people who successfully quit smoking or manage to lower their blood pressure; there are very few studies that support lowered risk of heart disease in people who undergo treatment for depression.

Heart Disease

A large cause for this might be that for most people who suffer from depression don’t ‘quit’ depression the way they quit smoking. Even with proper treatment, depression isn’t known to ‘lower’ the way blood pressure lowers when treated properly. And as with many psychological issues, neither cause nor effect is as clear cut and easy to draw conclusions from.

Carney and Freeland are undaunted, however. They are ready to begin new studies with different approaches to treatment for depression so they can determine if these new approaches conclusively show a decrease in lowering heart problems. For now, it is clear that treating depression might effectively impact both the health and quality of life of a person and so, the commitment to continued research lives on.

Citations Circulation, Feb. 24, 2014

ABOUT THE AUTHOR:
Judy is a licensed clinical social worker and has worked extensively as a counselor with children, adolescents, couples and families. Judy’s professional experience in the mental health field along with her love of writing, provide insight into real-life experiences and relationships. Her fresh voice and down-to-earth approach to living a happier, more meaningful life are easy to understand and just as easy to start implementing right away for positive results!

What we do with our women

5 Minutes Of What The Media Actually Does To Women

 Brandon Weber

What do we do with the women in the society when images of women on the internet are manipulated ? What attitudes do we want to transfer to our children? What kind of people do we want to be?

True fact: Almost 100% of the images you see of models and celebrities are altered.

 

Aren`t you good enough as you are?

Nina, psychologist

Mindfulness and Trauma

Stability

Mindfulness is about stabilizing. Studies have shown that people who have experienced trauma can benefit highly from this type of work. (Cullen, 2011). When people have experienced trauma, they can be challenged with high levels of stress, anxiety and depression at any time.

When we increase focus, stress and anxiety decreases, and as insight increases, depression may also be reduced. The implications of effective mindfulness on these specific features are truly significant and the more studies that are being done, the stronger the evidence of effective results of mindfulness.

When a person experiences trauma, racing thoughts and chain reactions of distressed thinking and intense emotions are more frequent, more intense and can last for longer periods of time. The thought pattern easily becomes negative and thereby creates greater levels of anxiety and depression, especially if ignored.

What mindfulness does is brings us into the present moment. Being in the present is provides direct opposition to the racing thoughts which are based in the past, thoughts about things that have happened, or based in the future, worrying about things that might happen. When we practice mindfulness, we pull away from these past and future thinking patterns and redirect ourselves into the moment, grounding ourselves in the present where we regain the ability to address the negative emotions of anxiety, stress and depression that are associated with our thoughts.
We can, for example, tell ourselves that in the present moment, there is nothing bad or harmful occurring to us. We are most likely sitting or lying quite comfortably in a safe place where we can focus on slowing down our breathing and letting the negative feelings go as we exhale. We can ground ourselves and regain our stability, acknowledging the feelings but proving to ourselves that in this present moment, we are okay…we are fine…and we are safe.
We have managed to regain control over the intense emotions that were beginning to overwhelm us. We have become more aware, more able to calm ourselves and less of a victim to our run-away thoughts.

Kabbat-Zin (1994) provides this definition of mindfulness: “paying attention in a particular way; on purpose, in the present moment, and non-judgmentally.” We are actually doing an awful lot although it seems we are doing nothing. We are freeing ourselves and giving ourselves permission to just be in the moment. And it is extremely soothing. It is like allowing our mind to float and just immerse itself in now.

It is very important for people to work out their own form of practicing mindfulness, something that works for them. I strongly advise people to do some research on it and see what feels like it might be a way to begin your personal journey.

Attention

Remember that the point is NOT to empty our thoughts but rather to pay attention to them in a purposeful way without judging them and then refocus attention onto whatever it is you were focusing on prior to the thought popping up. Mindfulness is a journey of exploration, discovering sounds, textures, shapes, temperatures, things that always exist but that we don’t focus on because we are not being mindful to them.

If you are just starting out, I suggest just a 10 minute exercise in which you find something to focus on, an object to look at or hold perhaps. It is wonderful if you become adept enough at it to practice it when you begin to notice any negative thoughts or symptoms that you are trying to decrease such as depression, racing or distressing thoughts, etc.

Snoopy Writing

There is a wealth of information available on mindfulness as more and more people are finding it beneficial to many different situations they encounter. I would love to hear from you about your mindfulness journey and results. Feel free to comment or contact me directly.

ABOUT THE AUTHOR:
Judy is a licensed clinical social worker and has worked extensively as a counselor with children, adolescents, couples and families. Judy’s professional experience in the mental health field along with her love of writing, provide insight into real-life experiences and relationships. Her fresh voice and down-to-earth approach to living a happier, more meaningful life are easy to understand and just as easy to start implementing right away for positive results!

Taking depression for a walk (II)

downboyblog

In a previous post I started talking about walking and depression. I’ve mentioned that my therapist’s first treatment recommendation was a 30 minute walk per day. In a world with sophisticated drugs and psychological treatments for depression, can something as simple as walking make a difference? Is it relevant? Let’s find out:

A Harvard Medical School publication on the topic sites a number of interesting findings:

• A literature review dating as far back as the eighties concludes that exercising regularly can lead to improvements in mood for people with mild to moderate depression, and be a treatment support for severe depression sufferers
• A 1999 study found that participants who took part in an aerobic exercise program fared as well as participants taking  an antidepressant, and a third group who received both treatments. Interestingly,  the group taking antidepressants only reported the quickest improvement in mood, but participants who continued exercising after…

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