Better Living Through Psychology

If you were planning to attend the “Learning ACT” training program, unfortunately I have had to cancel it due to insufficient enrolments.

This also means that the supervision group will not be meeting.

There are no plans right now for the supervision group to be restarted (not by me anyway - if you want to run it, contact me and I’ll help you get started!)

Many clients wonder why I so frequently ask them questions about how the session was, whether we are on the right track, whether there’s anything I did or said that didn’t work for them, and so on. Some also wonder whether it’s really worth the effort to record their session ratings. (I use a session rating scale that gives me feedback on whether the person felt heard, whether we are talking about what is important, etc. If you are a therapist you can obtain this instrument from www.talkingcure.com)

I appreciate you may feel these questions and the rating scales are burdensome and unnecessary. After all, you’ve come to see me to get help with your problems, not to help me learn how to do therapy better. That is quite a valid point of view, however recent research at Brigham Young University showed how seeking this feedback can at least help protect you from ‘bad’ therapy. Richard Friedman discussed this research in New York Times article. His advice for seeking a good therapist is worth quoting:

In a study published last month in the journal Psychotherapy Research, Michael J. Lambert and Cory Harmon, psychologists at Brigham Young University, gave psychotherapy patients a questionnaire about how they were feeling and functioning. They randomly gave feedback from the questionnaires to half the patients’ therapists; the other half received strengthened feedback, which included patient self-assessment plus specific information about how the patients viewed their therapists and their social supports. These two groups were compared with a control group of patients whose therapists received no feedback.

The researchers found that giving feedback to therapists clearly improved treatment outcome: When therapists received no feedback, 21 percent of their patients deteriorated. With therapists who received regular feedback, 13 percent of patients deteriorated; with strengthened feedback, 7 percent of patients deteriorated.

The clear implication is that therapists are not always the best judge of how their patients are doing, perhaps because they are blinded by their own optimism and determination to succeed.

Some therapists might even view worsening during treatment as a sign of progress — a misguided “no pain, no gain” view of psychotherapy.

It’s probably easier to say what is bad psychotherapy than what is good, but there are qualities that all good therapies share. You should feel that you are understood as an individual, and that your therapist is compassionate and nonjudgmental. Good therapists should be able to explain the nature of your problem, and which of several treatments might help you.

Protecting you from treatment deterioration is important. There is a medical principle called primum non nocere - first do no harm. In other words if you come to counselling for help, you should expect at least not to be any worse off. However, like any treatment, psychotherapy has its treatment failures.

Most studies in this area show that, depending on the therapist, negative treatment outcomes are likely in an average of 10% of cases. Which therapists have the worst outcomes? The ones who don’t ask for feedback from their clients.

Of course, I’m not so naive or arrogant as to think I won’t have treatment failures like anybody else. But if that is going to happen, I want to find out as soon as possible so that I can change my approach or refer that person to someone more suitable.

I haven’t written anything for some time, but this quote just really set me off:

According to University of Massachusetts mathematicians Tanya Leise and Hava Siegelmann, jet lag happens because different systems in the body have different circadian rhythms. For example, cells in your digestive system prepare for digestion at particular times of the day. Secretion of the sleep hormone melatonin is higher at night and lower during the day. Fortunately we are equipped with a ‘master clock’ - a brain structure called the suprachiasmatic nucleus (SCN) - which effectively keeps things synchronized.

Leise and Siegelmann suggest that when the ‘local clocks’ are disrupted, say by travelling to a different timezone, the SCN can take some time to adjust. How long this adjustment takes depends on a variety of factors, such as the strength of the connection between the SCN and the ‘local clocks’, and of course the rhythm of those clocks.

To find out how this hierarchical system works, Leise and Siegelmann developed a model that incorporates data on circadian rhythms, on the factors that cause them to change and adapt and on how they respond to ‘commands’ from the SCN. Simulations the researchers ran showed the system gets most disrupted when the ‘master clock’ is shifted forward by 5 to 8 hours. The reason this disruption happens is that as the master clock adjusts by shifting in one ‘direction’, for example jumping forward to six or seven hours ahead, other ‘local clocks’ have tried to adjust by going backwards or delaying, by say 18 or 17 hours.

HOW CAN I USE IT?

• Make time zone adjustments gradual whenever you can. Ideally, travel across four hours of time zones, have a one or two day layover and then continue.
• Of course on longer flights that suggestion won’t be possible, so try this:

Take a look at this article from MSNBC:
Placebo’s power goes beyond the mind

For years, scientists have looked at the placebo effect as a nuisance - just a figment of overactive patient imaginations. People who got a dummy medication as part of a clinical trial believed they were better, but really weren’t. But new research shows that belief in a dummy treatment leads to changes in brain chemistry.

and another excerpt says:

Recent reports show that anticipation of relief from a placebo can lead to an actual easing of aches, when the brain makes more of its own pain-dousing opiates. Brain scans of Parkinson’s patients show increases in a chemical messenger called dopamine, which leads to an improvement in symptoms when patients think “mistakenly” that they are receiving real therapy.And studies in depressed patients … have found that almost as many are helped by placebo treatments as by actual medications. In fact, as it turns out, a person’s response to placebo treatment may offer clues as to whether œreal treatments with antidepressants are likely to work.

WHAT DOES IT MEAN?
Firstly, it’s more backing for the notion that the patient’s motivation and belief in the treatment method has at least some curative effect. In the psychotherapy outcome research it’s well established that the client’s motivation to get well along with their belief in the counsellor have more influence over a successful outcome than the treatment approach or techniques of the therapist.

HOW CAN I USE IT?

• It’s tempting when you’re in pain to focus on how bad the pain makes you feel, when it will pass and what you can do to stop it. Understandable, but such thinking really reinforces the notion that “the pain is here now and I don’t like it!” What about assuming that some time soon, the pain will stop or at least reduce?
  What enjoyable experiences are you missing out on while you are focused on your pain? Seek out people, places and activities that you enjoy. Not as a form of distraction though, but because those things are worthwhile in and of themselves. Rather than try to distract yourself from the pain, I’m suggesting you acknowledge the pain even as it accompanies you in doing the things you enjoy.