Friday, August 17, 2018

Comments by Gerard

Showing 64 of 64 comments.

  • We may be giving way too much credit to CBT as something that can cause adverse effects. It is those psycho technicians and psycho educators (I find it hard to call this lot therapists) that cause the damage. A small percentage of people sees a psychologist for “symptom relief” and unfortunately the majority of “CBT therapists” are not equipped to meet other needs clients might have.

  • Sounds wonderful, but by focusing on the burned out employee (as if it they are lacking the resilience or robustness to deal with workplace stress) it diverts attention away from the myriad of organisational factors that contribute if not cause people’s worries and distress at work. The organisation doesn’t need fixing, only the individual. Sounds familiar?

  • Shaun f, you said “most of us professional therapists don’t adhere to the medical model much”. When you think that people respond based on their “strong emotions”, then you have ignored the whole context of the discussion, blamed people for being irrational and you as the authority had nothing to do with their reactions – that is exactly what the medical model does

  • I don’t think anyone has denied that a fear of needles actually exists and that it can be very distressing. What is worth considering though is that a fear of needles may not be a fear of needles. For some people there may be a displacement of a fear of something more abstract but nevertheless still threatening into something more concrete (such as needles, or dogs, or heights, etc.) in order to manage (avoid and control) better with that. Unfortunately I can’t cite any scientific psychological research to support these wild claims that these peoples’ fears may be very unique to them and that they have absolutely nothing in common with people who are actually afraid of needles based on injections gone wrong in the past

  • Brett, how can you know that your needle phobic client was helped more by the technique you used than by your care and respect for and genuine interest in helping them, your confidence, their perception of your expertise or their trust placed in you? My point is no “evidence based research” can measure this and by ignoring these factors as contributors makes psychology appear “scientific”

  • Brett, I believe MIA comments on this not to promote any particular approach but to highlight that when psychology uses the term “evidence-based treatments” it is banging the drum of the medical model. This model is flawed on so many levels which I am sure I don’t need to elaborate on, but worth mentioning is the stigmatising and discouraging message of the problem “in” people, or put differently that they “have” some or other fictitious disorder as result of some or other inner failing yet to be proven. This cannot be supported in any shape of form and thus MIA should report on this

    On psychotherapy research I find the claims that this or that approach is more helpful/effective than others astonishing. There are so many factors, circumstances and variables that can impact on outcome and these studies do not and cannot account for that. Using the term evidence based is thus more a selling point than something based in fact – a money spinner for those in private practice while the simplicity of it all very alluring for prospective clients

  • We already know that physical activity/exercise has many benefits under various circumstances. The problem with studies like this is that there is the implied equation with actual conditions where exercise has proven to assist recovery and re-occurrence (for example, certain forms of cancer), and thereby trying to appear scientific and informative

  • Not sure why MIA would report on a study that views depression through a medical lense, that is, a condition with symptoms, treatment and preventative measures. Most importantly though, a lense that ignores context and the life circumstances which contribute to these feelings, provide explanations for it and should inform any efforts to assist us feeling better

  • The same type of problem? People tend to react and adjust to, make sense of and try and manage with what happens to them in seemingly similar ways because they are people. If you see these as their problems, then you and I are worlds apart in terms of how we think about people

    With regards to your last paragraph, I have come across people who described their CBT therapists as cold, technical and appearing to follow a script or recipe. Needless to say they didn’t experience these therapists as helpful, especially when their severe and chronic anxiety had an interpersonal origin (which, and this is where you and I might differ, is most often the case)

  • To say that a particular approach is specifically and uniquely effective for any kind of problem makes the people with that problem a homogenous group which they are not and it obscures context which you claim matters. I am sure you would agree that people aren’t their presenting problems and that therapy requires a creative mind to assist this person at this particular point in time of their lives under these circumstances. As Steve mentioned elsewhere you have to re-invent therapy for every client. The one size fits all approach seems too simplistic for all our complexities

  • Agree with Steve. Therapy is not a bag of tricks, but a relationship. Once people feel connected with someone else, safe, respected and validated a lot of things seem to fall into place for them anyway. Not saying this is all they need as that will depend on their unique situation. CBT however goes from the standpoint that all people need is symptom relief, that their techniques will work for any client, under any set of circumstances which is medical model thinking in its pure form

  • “practitioners should stay up to date on all treatment options and present them to patients in a transparent and balanced way.”

    I will have a go at this: “I need to tell you that there is no such thing as “generalised anxiety disorder”, the thing your GP referred you for. I am not sure how they researched treatment outcomes in trials for something that doesn’t exist and therefore I am unable to tell you what will work for this thing you supposedly have. What I can tell you is that you and I may be able to figure a way out to work together on what is going on for you. There is no one size fits all in psychotherapy and knowing what will work for you in your unique circumstances may take some time. I will not charge you until we know if and how we are going to proceed. How does that sound?”

  • Personally I like the link that has been made between needs and more specifically threats to those needs and how people react, adapt and attempt to change their circumstances as an explanation for their “symptoms”.

    This framework is long overdue and well done to the BPS for showing initiative in this regard. The American Psychological Association and the Australian Psychological Society should be ashamed of how they have continued to live in the shadow of big brother psychiatry and how they have endorsed the lies and misinformation from this pseudoscience.

  • “In this climate of profoundly disrupted relationships the child faces a formidable developmental task. She must find a way to form primary attachments to caretakers who are either dangerous or, from her perspective, negligent. She must find a way to develop a sense of basic trust and safety with caretakers who are untrustworthy and unsafe. She must develop a sense of self in relation to others who are helpless, uncaring, or cruel. She must develop a capacity for bodily self-regulation in an environment in which her body is at the disposal of others’ needs, as well as a capacity for self-soothing in an environment without solace. She must develop the capacity for initiative in an environment which demands that she bring her will into complete conformity with that of her abuser. And ultimately, she must develop a capacity for intimacy out of an environment where all intimate relationships are corrupt, and an identity out of an environment which defines her as a whore and a slave.” – Judith Herman in Trauma and Recovery

    I guess we would all be irritable under these circumstances

  • Hello Steffen
    Thank you for your reply. “Evidence-based CBT” has to assume that those “mental illnesses” it treats are actual disease entities (as opposed to reifications) and that is where it all falls flat for me. CBT is an extension of medical model (let’s locate the problem in the individual) thinking and therefore cannot be taken too seriously as an approach that accurately and thoroughly explains (and by implication effectively addresses) people’s distress

  • Whenever I see articles mentioning CBT, I think of what psychologist, Oliver James, said in an article in the Daily Mail: “However filthy the kitchen floor of your mind, CBT soon covers it with a thin veneer of ‘positive polish’. Unfortunately, shiny services tend not to last. CBT fails to address the root cause of many people’s problems, which often stem from traumatic experiences during their childhood.”

  • “Global Impression-Improvement (ES = 0.46), with 47% of those on micronutrients identified as ‘much’ to ‘very much’ improved versus 28% on placebo”

    Subjective ratings on “much” to “very much” improvements and the fact that 28% on placebo improved really don’t give me confidence that this trial showed us anything

  • “What a a delight when we hear that the kids we have treated are making friends, experiencing positive interactions with their families, sleeping and eating well.”

    It may just be that these changes are a result of some interest showed by the parents and yourselves and not because of the changes in what they ingest

  • I never use the term (or any of “diagnostic labels”) and encourage everyone around me not to either. It is a hollow and lazy way to refer to, describe or try and understand 1) our reactions to adverse social and material circumstances and/or abusive/toxic relationships, 2) our attempts to still meet our needs, feel safe or find meaning under these circumstances and 3) how we communicate what is going on for us in such circumstances

  • I am not sure how you conduct studies like this without making the assumption that depression is a thing to be studied, that people with depression are a homogenous group in respect of those aspects that could contribute to low mood, that “depression severity” as subjectively experienced by them is something all can agree on, that they all made sense of their distress in the same way and that in nine years there were no other variables that impacted on how the feel about themselves and their lives

  • Whenever I see research like this I always wonder how do you account or control for the impact of the relationship with the therapist, the support surrounding the child when not seeing the therapist and other extraneous factors that either help them along or hold them back. But research ala the medical model with it’s seductive simplicity only focuses on one active ingredient and that is the particular technique used or pill swallowed while ignoring the fact that people during the research period live in particular circumstances that have far greater and lasting impact on how they feel and make sense of things

  • Why is MIA interested in articles that promote disease talk and genetic predispositions? No child is at risk because the parent “had” an “anxiety disorder”. Anxious parents may certainly rear anxious children for obvious reasons and if a child at that age is anxious as a result of mistreatment and abuse at the hands of the parents, no amount of correct breathing, conflict resolution and social skills training is going to help them. This reminds of the Australian psychiatrist who was able to pre-empt psychosis in “at risk” young people and wanted to put them on “anti-psychotics”, just in case

  • You have to wonder about “therapists” who prefer to deal with people at arms length in an online format. I have always thought people seek connection with others and that they want to have a real relationship that can serve as a source of comfort, a safe space from where changes can be explored and a practice ground for how they relate. I am obviously out of touch – people’s difficulties cannot be mediated through a relationship. All they need to be taught via text is that their thinking is way too negative and to breath correctly when they get “triggered” and we can be sure that they won’t “relapse”

  • The attractiveness of the medical model is it’s simplicity and as such it claims that we can have treatment A applied to condition B and we will have outcome C. When psychology operates in such a fashion the result is so-called empirically supported or evidence based treatments like CBT. The problem with this is we know that the most important and telling “active ingredient’ is not the approach or the technique, but the therapeutic relationship, the conditions to be targeted have a dubious existence to start off with so what is in fact being treated and most people who seek therapy don’t just want “symptom relief” as an outcome, but able to make changes, live with a purpose, feel in control again, understand themselves better, have satisfying relationships, etc.

    I can only hope that psychology will one day feel that they have a right to exist as an independent science and discipline and that they don’t have to copy and pander to the pseudoscience of psychiatry

  • It is not surprising that if you have psychologists being trained with the medical model as backdrop, then your product will be someone who believes that they use “evidence based treatments” (usually CBT) for particular conditions (MDD, agoraphobia, GAD, etc.). Just like doctors they don’t treat people, but their “illness” and thus there is no need to consider context, how a person’s life has unfolded given his/her circumstances or what might have caused or contributed to their distress – all you have to focus on is symptom reduction and that is also the only feedback you need to elicit from them. When they “relapse” after 3 to 6 months (which is usually the case), you can blame them for not using the skills that you have taught them or that they were not overly “psychologically minded” to start off with in the first place. To these psychologists technique is everything and the relationship a mere practical coincidence. I see this particularly here in Australia and remain hopeful that one day the profession as a whole will look back and recognise that, first and foremost, people in distress need connectedness with others and that there needs to be a far greater emphasis in psychologists’ training on selecting people who have natural facilitation skills, empathy, kindness and respect as opposed to the current trend of selecting the most academically successful ones and turning them into psycho-technicians (I can’t think of another way of describing them)

  • Childhood adversity may increase risk of suicide? Looking at the situation of Indigenous Australian children the rate of substantiated abuse (that is, a statutory protection authority believed that abuse or neglect had occurred) is 4.3 times higher compared to non-indigenous children and one needs to assume this is a gross underrepresentation of the problem as about 90% of sexual abuse alone goes unreported in these communities. Indigenous youth suicide was 80% of the total Australian suicide in 2010 and in the Kimberley region (northern part of Western Australia) there is on average one Indigenous youth suicide attempt every week

  • “Treatment Resistant Depression” as a justification for brain shocks shows how “innovative” psychiatry can be by inventing a condition to explain away why their miracle drugs have not worked and thereby continuing to locate the problem “in” the person. As such the social factors contributing and maintaining the distress can conveniently be put in the “too hard to deal with basket”. I guess complexity has always scared psychiatrists a little bit

  • “mental disorder has something profound to teach us about the nature of being human. And it does this not by reflecting brain abnormalities, but by consisting of extreme, bizarre, usually dysfunctional and sometimes unfathomable manifestations of human agency.”

    I would have said: “all human behaviour has something profound to teach us about the nature of being human and that we should avoid value judgments and the use of loaded words like extreme, bizarre, dysfunctional, disordered, etc. as these are sure to cloud and limit our understanding of others and of how they make sense of their lives.”

  • My apologies for the fence sitting comment as I have misunderstood your use of the word medication. A lot of people reading the blog would understand medication as those drugs (marketed by pharmaceutical companies and prescribed by doctors) that interrupt a disease process or correct some physiological abnormality. If I understand you correctly this time round you use it in the broader sense as anything that someone can derive benefit from whether this is psychiatric drugs, alcohol, crystal meth or chocolate. In that case I would suggest you use the term “remedy” just to avoid confusion with actual medication.

    I think that we have made huge progress just because we have questioned and critisised the disease model and many professionals are no longer trapped in that narrative. To me the best example is the Division of Clinical Psychology (BPS) who has publicly stated the problems and limitations of the disease model – I live in hope that the Australian Psychological Society would one day wake up to that too

  • Good Day Tim, entertaining article, but you lost me on the medication part of psychotropic medication. We all know about the problematic side of these drugs, but please explain how people are “medicated” when using it, that is, treated for a disease? Also, if you are not anti-medication, please let us know for which diseases and disorders should medication be taken then and what are the benefits you are referring to? I don’t believe you can be a fence sitter like you are on this issue

  • Just wondering if any research has been done on whether particular individuals find “anti-depressants” more useful than others. For example, dependent, slightly naive and gullible types who would not readily question authority and easily slip into the passive-recipient patient role or people whose self-esteem and moods are more externally regulated (and one can reasonably assume that such issues stem from some form of abuse). If so, then doctors have under the guise of “help” taken advantage of really vulnerable people and ensured that their “mood problems” are perpetuated and thus also a steady income stream

    I applaude MIA and its efforts to better educate and inform

  • Your story reminds me of my own experience as a clinical psychology intern at a psychiatric hospital some 25 years ago. What struck me then was how self-perpetuating and self-serving psychiatric “care” was and that in my 12 months stint saw many people return after their discharge. There was no actual involvement with the patients or preparation for life outside the hospital walls. When I encouraged a female patient to refuse the “medication” she was injected with on a regular basis as it had such severe side-effects, I was called irresponsible. And when a young man who had received more than 60 electric shocks to the brain before the age of 18, asked me whether he was a schizophrenic during an intake interview and I said to him no, you are (his name) and that it was just a label that psychiatrists use to substitute any real connection with him, I was chased out of a ward round like a rabid dog. This was fortunately towards the end of the internship and they were happy to see me go.

    For a few years after that I questioned my own position which was shaky to say the least following the experiences at the hospital. Then I read Toxic Psychiatry by Peter Breggin. He eloquently stated what I intuitively knew and since then have in my own small way with my clients made sure that the psychiatric doctrine does not get promoted in any shape or form. I am also encouraged by the contributors and readers of MIA