What is psychotherapy and how does it work?

Research as shown that five elements should be present for a psychotherapy to be effective (Weinberger, 1995):

  1. A positive therapeutic alliance (relationship between the client and the therapist)
  2. Helping the client confront what s/he has tried to avoid
  3. Revival of hope
  4. Increased sense of mastery and competence
  5. Attribution of success to one’s own efforts

This brief article will examine several modern psychotherapies in light of these elements.

A bit of history. There have always been people to whom we go to talk about our problems. In the modern world they are doctors, psychologists, social workers and other health practitioners.

Modern psychotherapy came out of the work of Sigmund Freud in the late 19th and early 20th centuries. His insights into human behavior helped him develop psychoanalysis. This form of psychotherapy is the first of the many modern forms of therapy that we know today.

Analysis involved his patients (he was a doctor and the medical approach was the only one around at that time) lying on a couch and talking about their problems. He called this type of talking ‘free association’ as the patient talked freely about anything that came into her mind. He maintained that the patient’s talking was in fact directed by unconscious conflicts that were causing the problems she came with. The therapist’s job was to offer interpretations at key moments that brought about changes in the patient’s insight and so led to changes in her life

By making the unconscious conscious, the “talking cure’ helped patients to gain insight into their problems and make changes in their lives.

Psychoanalysis gained a bad reputation for being long and expensive for little improvement. In an attempt to address this, short forms of what is now known as short-term ‘dynamic’ psychotherapy have been developed. ‘Dynamic’ means that the therapy acknowledges there are unconscious forces or dynamics at work in the person’s psyche that create conflicts within him and lead to the problems he presents with in therapy.

The short form that has the best evidence for being effective is Intensive Short-Term Dynamic Psychotherapy or ISTDP. This approach takes a more active stance to the person and does away with the couch in favour of two chairs as is usual in therapy today. Short-term therapy is regarded as less than 40 sessions.

ISTDP is an attachment-based therapy that recognizes that when we engage in relationships with others, old attachment feelings are awakened. We become defensive about the feelings and closeness to others and/or we become anxious and adopt unhealthy patterns of responding to our feelings and the people who come close to us. This causes depression, anxiety, distance in our relationships and problems being productive in work, lack enjoyment and often lack insight into ourselves.

ISTDP and other emotion -focused therapies see it as vital that the client experience emotions in the session in a safe and healing way. There is considerable evidence that the full-experience of emotions gives a more effective result and people have less medication, return to work and have more healthy relationships following such therapy.

Because emotions are physical (in our body) as well as psychological (in our mind) ISTDP focuses on the physical experiencing of feelings so the client can accurately identify and understand his own feelings and not remain depressed or anxious. There is growing interest in these approaches as the body of evidence for effectiveness grows.

ISTDP uses techniques including assisting the person to be aware of her own emotions in her body and mind, and to experience the emotions in the session, including the emotions that the person wants to avoid. This is an active therapy and involves a partnership between therapist and client to achieve the client’s goals.

Many approaches to helping people change through a “talking cure’ have been developed since Freud’s lifetime. The most common approach used today is Cognitive Behavioural Therapy (CBT). This has a solid evidence base but notably recent evidence is not as strong as for early studies.

This approach is based on the idea that most problems occur because of faulty/distorted thinking and habits of acting that no longer work in the person’s life. Examples include thinking styles such as ‘black and white thinking’ or ‘overly negative thinking’. This requires strategies of cognitive restructuring (helping the person to think in more reasonable and balanced ways), response scheduling (adopting regular and scheduled changes) and response prevention (stopping old patterns of behavior that no longer work) among others.

The CBT therapist identifies these thinking styles with the client and provides strategies and homework to reinforce insights and assist them to make the changes to the way they respond to the problem situations in their life.

Another common approach is Interpersonal Psychotherapy. This is most often used for treatment of depression. This approach understands the problems people have as caused by changes in social roles and the way these changes have affected interpersonal relationships. It is these changes in relationships that cause depression. This therapy has a ‘here and now’ focus. It is not focused on the past but on how the person is functioning in the present.

There are many new types of psychotherapy that are proving popular. These include Mindfulness-based therapy, Acceptance and Commitment Therapy (ACT), and some approaches based in the positive psychology movement.

Mindfulness is an ancient technique that is practiced by Buddhists and has become very well known in the west in the past 60 years. It involves being attentive to your current experience, remaining present to yourself, your activity or inactivity and your surroundings. By being attentive and noticing yourself you become aware of the truth of yourself, your desires, feelings and urges. This enables you to make choices that are more grounded in what is actually happening in your life rather than from your thoughts alone, which may or may not be a good indicator of what is good for you.

Meditation is the most common form of mindfulness and is taught by many practitioners today, some more reputable than others. Used as a technique within many types of psychotherapy it is an effective way to assist the client to be aware of her own internal experience, particularly of her own feelings.

Acceptance and Commitment Therapy (ACT) is also proving popular among therapists. The aim of ACT is to enable the client to accept what is out of her personal control, and commit to action that improves her life. This approach is focused and can be applied to many life problems including depression and anxiety.

ACT uses techniques common to many psychotherapies. These include assisting the client to be present and identify his experience, and of course mindfulness, with or without meditation.

So when you are choosing a therapy, ask yourself:

  • Does the therapy tick each of the above five points?
  • Is there evidence for it being effective for the problems you are experiencing?
  • Are there sources of evidence that are reliable, such as independent university studies?

Do your own research. This is a brief survey that should lead you to the Internet for more information and to ask others who have been to a therapist. Keep in mind though that their experience will not be your experience. The dynamic between therapist and client is always unique to each person. So your friend’s experience may not be yours. That said, if it ticks the five elements and you can answer the questions above, you should at least avoid harmful experiences at the hands of charlatans who may promise you that you will get better if they slap a couple of salmon together over you and chant ‘Om’.

Disclaimer: Bernie McCarthy practices ISTDP.

 

 

When someone you love has a mental illness

Living with a serious mental illness affects not only the person with the condition but everyone in the family. Mental illness can take many forms.

The most common are anxiety conditions such as panic, phobias and generalised anxiety; depression, schizophrenia, bipolar disorder, eating disorders, and obsessive-compulsive disorder.

A person with a mental health condition is likely to experience considerable tension and distress in their lives and this can affect those around them. Apart from this their behaviour towards others in the family and to those outside the family can often cause concern and strong feelings in those closest to them. This can be in the form of anger, fear, grief or confusion, particularly if the behaviour is aggressive, repetitive or unusual.

You may find you are grieving for the person that you once knew and now cannot see in the person they have become. This grief may need time and patience to understand as you come to grips with the changes in the person’s life and trajectory. The dreams you had for them may no longer be possible and this may take some time to adjust to.

However, it is important to remember that most mental health conditions are in the form of ‘episodes’. This means that they are not necessarily permanent or the changes enduring. People recover from mental illness and often learn a great deal about themselves in the process. This can help to become more insightful and informed and often better people to live with as a result.

If the person is your child or your sibling

It is important to have open communication in the family when a member has a mental illness.

Talking with each other about the problems other family members are having can relieve a sense of isolation that can arise if everyone stays silent and doesn’t talk about what is happening to the family. By sharing it you can work together to support and encourage each other and prevent further problems occurring in other family members.

It is common for those caring for someone with a mental health condition to experience anxiety and depression themselves. So looking after yourself with time away or just getting outside the house to walk around the backyard can be essential to maintaining your own mental health. Keep up a balanced life as much as possible with breaks, changes of scene or setting, or connecting with friends via phone or skype or email. This can relive the isolation and ‘cabin fever’ that can occur.

Always keep reminding yourself that the person themselves is still there and relate as normally as possible with them so they can keep up the bond with you as much as possible. Avoid speaking to them as if they are a patient or sick. Normal communication is very important in helping them to find their way back to you when times are difficult for them.

Be clear about what is acceptable or OK behaviour in your family home and make sure everyone is on the same page so that acceptable behaviour is affirmed by all members. For example, it may not be OK to swear or use a loud voice or be aggressive so that others feel afraid.

If it is possible you may need to gently and firmly remind the person of what is OK and not OK, always remembering to do it in a way that lets them know they are loved and accepted but that it is their actions that are not OK. Letting the person know they are loved and valued regardless, is a vital part of remaining connected with the person who is unwell. Sometimes this has to be said quite explicitly, more than you might in everyday life with someone who is mentally well.

If the person is your partner

The person with the mental illness may be your partner, so communication about everyday things that usually don’t cause a lot of tension, may become muddled easily and arguments and emotional explosions can occur. If this has happened or is likely, you may need to be the party who takes responsibility for being clear in your communication so that you can help them to be as clear as possible about the everyday difficulties and issues that healthy couples experience.

Every couple experiences differences of opinion or points of view that can erupt into problems out of proportion to the real problem. In this case it is helpful to be calm and clear yourself. Know what pushes your own buttons and work out a plan for dealing with this moment in yourself so you do not explode and add to the emotional discharge.

Having a partner with mental illness may require you to do extra things, take more time or be ready to step in to make situations OK when they feel overwhelmed. As above you will need to keep a balance in your life if your role has become that of carer as well as partner. What do you need in your life to remain healthy in your own mind and heart? It might be keeping up a healthy diet, a hobby, maintaining friendships, regular exercise, or doing something together that is outside your routine. You may need to talk this through with someone you trust to get some ideas.

Be vigilant about domestic abuse (verbal, physical, sexual, emotional and financial) and be ready to care for your own interests by making yourself safe if that is necessary. If you have children and their parent is the person with the mental illness you may need to spend time explaining or debriefing with them about their experience or understanding of what has happened or just explaining the condition in ways that make sense to the growing minds. Often children do not need a great deal of information or very complex information. Rather they need honesty and clarity in small bites that satisfy their need to understand. They will come back later when they need more information.

Stigma

The way mental illness is viewed in society has improved a lot in recent decades. However, there is still some stigma or prejudice against people with a serious mental illness. You may be concerned about letting people know that your relative or friend has mental illness. Choose wisely to share information with people you trust and whose judgment is not going to be prejudiced but is more likely to be helpful and supportive.

When people ask, you may need to work out a way of explaining the situation in a manner that is faithful to the person you love and helps the other person to understand.

Get help from professionals

There are many organisations available now to help with information, ideas and practical support. Examples include beyondblue, and Mental Illness Fellowship, which provide education and information for carergivers, and for people with mental illness.

You are not alone and you will benefit from joining in education and support groups so that you can gain from the experience and wisdom of those who have gone before you.

 

Psychotherapy at McCarthy Psychology Centre

People who may benefit from therapy with Bernie McCarthy may present with the following conditions:

  • Anxiety (panic, agoraphobia, OCD, generalised worry, phobias, Post Traumatic Stress Disorder)
  • Depression
  • Medically unexplained symptoms (MUS) including chest pain, back pain, jaw pain, headaches and migraines, skin conditions including psoriasis and exzema, reflux and bowel disturbance
  • Eating disorders
  • Personality disorders
  • Fibromyalgia
  • Chronic fatigue
  • Transient cognitive disturbances such visual blurring, going blank, mental confusion
  • Relationship distress and life changes
  • Grief
  • Many of the above conditions will present with co-morbid depression/ anxiety.

For more information on the approach Bernie uses in therapy please click on the link here.

AGE

13years +

FEES

First session is a trial therapy of two hours – fee is $280.00 (out of pocket $155.50). Subsequent sessions 50-60 mins – fee is $195.00 (out of pocket $70.50). A low fee is charged for patients on government benefits and pensions and in some circumstances bulkbilling is appropriate. Discuss this with Bernie McCarthy

Medicare rebates under Better Outcomes for Mental Health program

AVAILABLE:

Monday to Friday 8am to 6pm

CONTACT FOR APPOINTMENTS

For appointments call 0408 145 819. The link above will take you to the page for details of location, fees, and Medicare rebates.

 

Anxiety gets in the way of talking

Have you ever noticed how anxiety gets in the way of expressing yourself fluently? Ever sat in an interview and frozen up to the point you knew you were talking nonsense and couldn’t do a thing about it? You want to say something really important and you clam up, freeze. Words don’t come. Mind numbing silence fills your head. Several minutes later when you are calm the words flow easily and fluently. And you beat yourself up for being so frozen.

Anxiety causes our verbal brain centres to cease working efficiently and it take considerable effort to manage the anxious thoughts that interfere with saying what we want to say. The verbal centres are located not far from the emotional areas in the limbic system of the brain, so emotional upset interferes with verbal expression. When we are relaxed we find the words easily but in front of an audience or in an interview the words are more difficult to produce. Anxiety gets in the way.

The fight or flight syndrome so often talked about is helpful here in understanding why it happens. When we are under threat it is not so helpful to talk your way out of it but more helpful to run or fight. Talking is a relatively modern human ability and our brains haven’t caught up with the effect of thousands of years of running or fighting.

It is worth noting that the anxiety literature also recognises “freezing” as the third option that common let occurs when people become anxious. Some people report such experiences when confronted with overwhelming trauma such as rape or other physical attack. Freezing is our way of staying still and maximising our chance of survival in the face of a marauding foe that is skilled at detecting a moving prey. Freezing can keep you alive.

However, to come back to our theme of the effect of anxiety on verbal skills, freezing can interfere with modern social function when we want to keep talking when we are anxious.

There is  useful information on  social anxiety on many of the anxiety website via google. One you could try is:

http://www.socialanxietyassist.com.au/

The more relaxed you are the better your words will flow. Several things are important to maximise your fluent speech if you know you are likely to be anxious and you know it may affect your performance:

1. Rehearse what you are going to say on your own. Then do it with a friend whose opinion you value. Ask for feedback. Do it again.

2. if you can visit the location so you are familiar with the situation. Walk up to the podium if you are speaking in front of a group. Check it out.

3. Be clear about the self-talk that chatters in your head. Is it undermining you or helping you? You need reasonable talk that is realistic and balanced. Find a statement that helps you to remain positive and realistic. Avoid being overly positive in your thoughts because that can be just as much of a problem as overly negative thinking.

4. Calm your physical signs of anxiety by breathing slowly and evenly for several minutes at a time. This helps in keeping oxygen and carbon dioxide levels in balance. Over breathing or shallow breathing can make you dizzy.

5. Keep up your usual activity so you avoid disconnecting from the world around you and getting lost in your own head. Phone a friend if need be.

Do you find these suggestions helpful? What do you do to manage anxiety or keep your verbal skills going when you feel anxious?