Long Term Psychotherapy Works Best
October 2, 2010 at 2:58 am (Individual Therapy)
Psychotherapy Works Best Over the Long Term
TUESDAY, Sept. 30 (HealthDay News) — People with complex mental disorders or personality disorders would benefit from long-term psychodynamic psychotherapy that lasts at least a year or longer, according to new research.
Published in the Oct. 1 issue of the Journal of the American Medical Association, the German study found that compared to the more commonly used short-term therapy, long-term psychotherapy left people better off. In fact, the number of therapy sessions the patients had was directly correlated to improvements in symptoms.
“Long-term psychodynamic psychotherapy was significantly superior to shorter forms of psychotherapy applied in the control groups. This was true with regard to overall effectiveness, target problems, and personality functioning,” said the study’s lead author, Falk Leichsenring, a professor of psychotherapy research in the department of psychosomatic medicine and psychotherapy at the University of Giessen in Germany.
“With regard to overall effectiveness, on average, patients with complex mental disorders were better off after treatment with long-term psychodynamic psychotherapy than 96 percent of the patients in the comparison groups. Thus, this meta-analysis provides evidence that long-term psychodynamic psychotherapy is an effective treatment for complex mental disorders,” said Leichsenring.
“This study provides a great value for doctors and for patients, and one would hope could have an influence on policy decisions,” added Dr. Charles Goodstein, a clinical professor of psychiatry at the New York University School of Medicine and Langone Medical Center in New York City.
Complex mental disorders include problems such as depression or anxiety that continue for long periods of time. Psychodynamic therapy, according to Leichsenring, is therapy that puts the focus on the therapist-patient relationship and the importance of developing that relationship. Leichsenring said this is a key difference between this type of therapy and some of the shorter-term options, such as cognitive behavioral therapy.
Leichsenring and his colleague, Sven Rabung, from University Medical Center Hamburg-Eppendorf, reviewed the medical literature to find studies that compared long-term psychodynamic therapy lasting a year or more to other forms of therapy. They found 23 studies with 1,053 patients. Eleven of the studies were randomized, controlled trials, and 12 were observational studies.
Overall effectiveness, resolution of the target problem, and personality functioning were superior in the long-term psychodynamic therapy groups than in the comparison groups, according to the analysis.
The bottom line: “Long-term psychodynamic psychotherapy is superior to short-term treatments in patients with complex mental disorders,” Leichsenring said.
But the problem, according to Goodstein, is that insurance companies often don’t want to pay for long-term therapy, perhaps believing medications and short-term therapy are more cost-effective options.
For someone who’s just started having symptoms — considered an acute problem — short-term therapy may be helpful, according to Goodstein. But, for those who’ve had mental health symptoms chronically, short-term therapy may boost them to a “barely livable level” but not to a good quality of life.
So, what’s the ideal number of visits? It really depends on the individual and their specific problem, but Leichsenring said, “there is evidence that most patients with acute distress benefit sufficiently from 25 sessions. For patients with chronic distress, about 50 sessions are required to achieve a response rate of 70 percent. For patients with personality disorders, there is evidence that about 200 sessions, or 2 years of treatment, are required to achieve recovery in 75 percent of the patients.”
More information
To learn more about psychotherapy, including psychodynamic psychotherapy, visit the America Psychiatric Association’s Healthy Minds Web site.
SOURCES: Falk Leichsenring, D.Sc., professor, psychotherapy research, department of psychosomatic medicine and psychotherapy, University of Giessen, Germany; Charles Goodstein, M.D., clinical professor, psychiatry, New York University School of Medicine and NYU Langone Medical Center, New York City; Oct. 1, 2008, Journal of the American Medical Association
By Serena Gordon
HealthDay Reporter
Putting Together the Puzzle of Psychotherapy
October 2, 2010 at 1:50 am (Uncategorized)
People in psychotherapy change at different rates. Most often I find that this relates to numerous factors. It may for
instance be related to the age at which a trauma occurred, complexity of current life situation and influences, interplay of personality characteristics, and so forth.
I use a puzzle metaphor to explain various aspects of the therapeutic process.
What takes place in treatment is similar to putting together a puzzle. There’s a catch to the whole process though. It’s as if we have all kinds of puzzle pieces for a puzzle and we don’t have the original picture from the puzzle box to guide us. There is something very interesting about the mind along these lines. It has been examined from Gestalt psychology with a process that is called “closure.” The idea of closure is that the mind fills in the gaps to produce a “unified whole” or a Gestalt. As we’re putting together the puzzle pieces about how you can become the person you want to become, more of the picture is obtained. There is a point at which adding just one more puzzle piece allows the mind to form a Gestalt and mentally see the final outcome. Once that happens, everything becomes clear as to the direction needed.
And this process also takes place on an unconscious level. The mind has built in self-corrective measures and begins searching for these corrective measures during psychotherapy. Automatically, while we are asleep and dreaming, or we are staring off into space thinking about nothing in particular, the mind continues this process.
I also use this metaphor to explain why some people are able to change rather rapidly and others take much longer.
Some people’s problems are like a puzzle that a young child might be able to put together. It may only have 8 pieces, and it only takes putting a couple of pieces together to get the Gestalt of the picture. Others are like a 1000 piece puzzle. This type of puzzle takes a great deal more searching, effort, and trial and error. It takes longer to be able to get that feeling of making progress. It takes longer to get the Gestalt of the picture.
Each individual has his or her own unique way of changing. Some patient’s will put most of the puzzle together before they make a single change. They have to know what the full picture is before they feel comfortable in changing. Sometimes this process happens completely unconsciously. Others are very deliberate, and utilize a great deal of conscious effort in placing each piece and make a shift or change with each piece that is connected.
Art Therapy with Trauma Survivors
October 2, 2010 at 2:08 am (Trauma Survivors)
Accessing traumatic memory through art making: An art therapy trauma protocol (ATTP)
• Article
The Arts in Psychotherapy, Volume 34, Issue 1, 1 January 2007, Pages 22-35
Talwar, S.
Getting the Most out of Couples Therapy
October 2, 2010 at 2:06 am (Couples Therapy, Uncategorized)
How to get the most out of couples therapy: you have made an important choice: to invest in the improvement of your relationship. By developing appropriate expectations and following a few suggestions, your investment in couples therapy can reap great rewards. This document is designed to help you get the most benefit from our work together.
In couples therapy, both the clients and the therapist have jobs to do. Your job is to create your own individual objectives for being in therapy. Like a good coach, my job is to help you reach them. I have many, many tools to help you become a more effective partner – and my tools work best when you are clear about how you aspire to be. My goal is to help each of you make better adjustments and responses to each other without violating your core values or deeply-held principles.
Goals of Couples Therapy
Your initial tasks will be to increase your clarity about:
- The kind of life you want to build together
- The kind of partner you aspire to be in order to build the kind of life you want together
- Your individual blocks to becoming the kind of partner you aspire to be
- The skills and knowledge necessary to reach your goals
To create and sustain improvement in your relationship requires:
- A vision of the life you want to build together and individually
- The appropriate attitudes and skills to work as a team
- The motivation to persist
- Sustained effort
- Time to review progress and make adjustments as necessary
Tradeoffs
To create the relationship you really desire, there will be some difficult tradeoffs and tough choices for each of you. Here are a few you can expect.
Time Investment
It simply takes time to create a relationship that flourishes, time to be together, play, coordinate, nurture, relax, hang out, plan, etc.
Discomfort
Expect emotional discomfort, as it is always part of the growth process. In therapy you will try novel ways of thinking and behaving, like listening and being curious instead of interrupting your partner, and speaking up instead of becoming resentfully compliant or withdrawing..
Expending Energy
It simply takes effort to sustain improvement over time. It will require effort to remember to be more respectful, more giving, more appreciative, etc.
Getting the Most from Your Sessions
By following these suggestions, you can make the best use of your time in therapy.
There are several mistakes couples often make in therapy. The first is showing up without a plan.
The second is the stream-of-consciousness approach. This happens when the focus of the session is on whatever happens to be on your mind at that moment.
The third is discussing the fight of the moment or the fight you had since the last session. Discussing these fights without also discussing what you wish to learn from them is often an exercise in spinning your wheels.
Here is a more useful approach to your sessions. Before every meeting, both of you should:
- Reflect on your goals for being in therapy
- Think about the next step you want to take to get closer to reaching your goals
- Be ready to discuss the outcome of your completed homework
- Give Your Success a Chance
It Takes Two
The blunt reality is that therapy requires time, patience, effort, and commitment from both partners.
Embrace Change
When it comes to improving your relationship, expecting and accepting change will take you far. While change can be scary, it is only through change that you can reach your goals.
Improve Your Relationship by Improving Yourself
It is typical for clients to begin therapy with the goal of changing their partners. You may think “if only she would stop doing ____” or “if only he would start doing ____ then everything would be fine.” If you want to have a better partner, you need to be a better partner.
Things to Think About
Finally, in this section I’ve included some things for you to think about. These ideas may help you better understand your problem, provide you with language to help you discuss your problem, or help you articulate your goals.
Getting Real
Marriages (and businesses) fail for the same three reasons. A failure to:
- Learn from the past
- Adapt to changing conditions
- Predict probable future problems and take preventative action
Can you legitimately expect your partner to treat you better than you treat him/her?
The hardest part of therapy is accepting you will need to improve your response to a problem (how you think about it, feel about it, or what to do about it).
Communication
The three most important qualities for effective communication are respect, openness and persistence.
It is essential for you to let your partner know what you think, feel and are concerned about. Partners can’t appreciate what they don’t understand, and people cannot read each other’s minds.
Most of the ineffective things we do in relationships fall into just a few categories:
- Blame or attempt to dominate
- Disengage / withdraw
- Become resentfully compliant
- Whine
- Denial or confusion
Effective communication means paying attention to:
- Managing unruly emotions, such as intense anger
- How you are communicating – whining, blaming, being vague, etc.
- What you want from your partner during the discussion
- What the problem symbolizes to you
- The outcome you want from the discussion
- Your partner’s major concerns
- How you can help your partner become more responsive to you
- The beliefs and attitudes you have about the problem
adapted from “How To Get The Most From Couples Therapy” by Ellen Bader, Ph.D. and Peter Pearson, Ph.D. http://www.couplesinstitute.com
Anne Aja, Ed.D.
Black Women, Racism/Sexism and Weight
October 2, 2010 at 1:57 am (Cultural Issues)
Is Racism (& Sexism) Making Black Women Angry & Fat?
I just completed a questionnaire about black women’s body image, eating habits and racism (shout-out to Vizionheiry for bringing it to my attention). I love participating in marketing and psychological research, so completing this survey was a no-brainer for me. The following warning made me pause for a few seconds, though:
The potential risk associated with this study is the possibility of discomfort in disclosing your feelings about yourself and your experiences in life.
But I jumped in anyway. Hell, I’m just thankful that someone cares enough to actually research these topics.
As I answered the questions, I began having some “aha!” moments. Questions about how we view ourselves that itemize our physical features helped me realize which parts of me I find more attractive than others and why. Questions about how much our self-evaluations of our beauty is influenced by others (specifically, black men) highlight how much of my opinions are based on my own values vs. other people’s values. Questions about how much of other people’s reactions to me that I ascribe to my race and how I feel about these illustrate the level to which I identify with “the black experience” – namely, the experience of being a victim of racism.
Yep, as I moved down the questions, it dawned on me why these beauty and racism topics are linked together. A great deal of Black women’s stress (numbing the pain -> overeating -> obesity), hostility towards other women (even other Black women), difficulties in interpersonal relationships, etc. can largely be attributed to, or at least understood through, our responses to this survey. It may also explain Black women (and men)’s easy camaraderie with other Blacks who can “feel their pain”, who have similarly processed the racism they experience, why certain Blacks are distrustful of Blacks who don’t wallow in their reactions to racism (as if not wallowing means they haven’t experienced the same level of racism), etc. So when given the option to receive the findings to this study, I jumped at this opportunity, too. These findings can be a great conversation starter for Black women to own some of our feelings about racism, and confront how these often suppressed feelings are affecting our lives.
I’m extremely in favor of ALL Blacks getting psychotherapy. Maybe if we did, Black women would learn how to recognize the symptoms of anger and depression that we exhibit without knowing it. Maybe if we did, Black Men would learn how to recognize how they contribute to our daily stress by compounding racism with sexism…and they’d learn how to understand and cope with Black Women’s Anger instead of entering interracial relationships solely based on the pretense of escaping this condition. Many of us complain about our voices being ignored. Well, here’s a way for us to be heard.
If you’re a Black woman, I highly recommend that you participate in this important study and share it with your sister circle. It took me about 27 minutes to complete (while multitasking).
Take the study here.
In the interest of pulling our skeletons out of the closet & facilitating some group healing, here are my responses to some of the social questions:
As someone with a marketing/psychological education and background, I greatly respect a well-designed questionnaire. The way the questions are split in this section between 1.) How often do you experience this because of race? and 2.) How much does this bother you? is brilliant. Very well-done.
What do you think of the idea of this research study? Do you plan on participating? What do you expect to be in the findings? Is there a connection between racism & Black women’s eating habits and body image? If you’re a Black woman, have you noticed a connection between your feelings of stress, anxiety, anger and loneliness and your eating habits? Can this research shed some light on the chasm between Black women and between Black women and Black men? What’s the one misconception about you or Black women in general that you would like to eliminate or clarify? If you’ve completed the survey, wanna share some of your responses/reactions? Anything else on your mind?
African-American Women and Depression
October 2, 2010 at 1:53 am (Uncategorized)
Stigma of mental illness: treating African American women for depressionPosted on July 28, 2010 by shlimentalhealth
Providers who successfully treat African-American women understand that treatment has to be personalized: contextually relevant to the client’s life. Black folks as a rule take extreme exception to being treated as “a case” of a diagnostic category. The quality of the interpersonal relationship regardless of the type of treatment is crucial to effective care outcomes.
One of the things that would help reduce the stigma of depressive illness is to more widely inform clients that: mild to moderate depression may be effectively treated with psychotherapy; and medication is more likely to be effective in severe cases of depression in concert with psychotherapy.
Our women need to know that therapy will help their unique and highly personal situation with clear benefits:
I can talk to somebody who will understand (my situation, race, religion, and family contexts).
I can change how I think view situations and think more positively in the moment.
I can learn about healthy options and practice preventative strategies.
I can practice new behaviors that will bring me peace of mind and/or social success.
I can get the emotional support that I need without burdening my family and friends.
I can learn to become more confident, empowered.
I can learn how to let go and let others do things for me sometimes.
I can feel worthy, unashamed, attractive, smart…
I can feel healthier, stronger, sleep better, eat wisely…feel well again.
More African-American women who have been successfully treated for depression need to have their stories publicized or shared among friends/family so that the word gets out: “I had issues and dealt with them. Hallelujah!”
Reference: Dr. Carlene Smith, Ph.D.
Student Health and Counceling Services
Hello world!
October 1, 2010 at 8:06 pm (Uncategorized)
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Talking about Why do we long for fictional worlds? | Psychology Today
January 25, 2010 at 4:05 am (Uncategorized)
