Psychotherapy 101

Many people ask, sheepishly, how psychotherapy really works.  The term “therapy” is mentioned constantly in the media as a short form of the word “psychotherapy.”  It’s natural that people are curious about something that is seemingly ubiquitous, yet apparently defies easy explanation.  There is nothing magical or new about psychotherapy.  Like most medications, however, there are aspects of its intrinsic functioning that remain a mystery.  The nebulous and fleeting words strewn about a psychotherapy session appear, mysteriously, to be less important than the conditions demanded by the therapeutic frame.  The “frame” of psychotherapy refers to all aspects of the session divorced from the actual words used within the session: for example, cost, time, place, office policies, etcetera.

Whatever the psycho-therapeutic school of thought, there are set features that are standard across most styles and techniques.  The most important element of effective psychotherapy is the promise of confidentiality.  Without a solid confidential therapeutic base, psychotherapy is nothing more than a Socratic conversation for hire.  One’s life may be blessed by many intimate trusted contacts, yet one cannot divulge literally everything to any one friend.  There are always social consequences, and consciously or unconsciously, all of us must monitor and filter the content of our conversations.  I do not believe that this encompassing social information management is strictly selfish.  As often as not, the filtering of information is used to protect the feelings of others.  Having intimate  friends is certainly important to one’s mental health, yet even the closest of relationships may be of little use when one’s situation is altered by psychological suffering.  For instance, most of my patients are very conscious of becoming a “burden” to others through ventilating their distress.  Unless the intimate attachment is based upon this sort of negative ventilation, the voicing of complaints may alter the basis of the friendship.  Existing social support may be lost.  For this reason alone, close friends are often of little help when psychological distress becomes significant.

Confidentiality is the boiler plate of psychotherapy.  Psychotherapy research of the last 50 years is convergent in revealing that the particular therapeutic technique employed is less important than confidentiality in achieving a favorable patient outcome.  Part of these findings may be explained by the decreased social risk obtained by ventilating to a professional.  Another aspect of these findings may be explained by the very nature of psychotherapy technique.  Each school of psychotherapy tends to focus on particular features of the human experience, yet similarities do exist.  Broadly, psychotherapy is dedicated to resolving problems that negatively affect one’s life.  The relative importance of thoughts versus behaviors differs, yet nearly all seek to identify “maladaptive” thoughts or behaviors that lower a person’s psychosocial functioning.  Many schools, such as Rogerian, eschew the whole notion of maladaptive, yet even the most positive and uplifting psychotherapy is seeking to alter one’s thoughts and/or behaviors.  It is unlikely that anyone would pursue psychotherapy as a treatment if they perceived their thoughts and behaviors to be wonderful.  Many schools of psychotherapy are better at appearing more positive and uplifting than others, but the mission is essentially the same.  For example, a new form of psychotherapy is termed “coaching.”  This form of psychotherapy/counseling even eschews the whole notion that it is a psychotherapy!  As in Rogerian therapy, there is a strong accent on the therapist being positive and proactive.  The word “coaching” is synonymous with “instructing.”  It appears that some people would forgo the benefits of an intimate attachment to a therapist, in order to avoid being perceived as a “psych case.”

Erections with the help of the gels cialis pills canada can lasts up to four (4) hours. Moreover, you can avail the benefits best prices on sildenafil of discounts and offers, if you purchase it in bulk. Erectile Dysfunction is an viagra pfizer online inability in men who are afflicted with ED. And hence men have buy cheap cialis to take care even as selecting treatment. Schools of psychotherapy are targeted towards individuals, couples or families.  While the number and relation of the individuals is different in various schools of thought, the mission to discover less than desirable thoughts and behaviors is the same.  Many therapists and schools of thought voice a focus on “communication.”  I am at a loss to know what else could be a focus of psychotherapy.  All psychotherapy assumes communication as essential to the experience, since no therapeutic school pretends to work with comatose or catatonic individuals.  Nonverbal behavior communicates a great deal to the therapist and others involved in the session.  Verbal and nonverbal communication is the very stuff with which we work, such that the notion of “communication” being a special focus is a bit absurd.  The greatest difference between psycho-therapeutic schools of thought are that each tend to emphasize particular features (subsets) of the therapeutic experience; thoughts versus behaviors and individuals versus groups.

If I may draw on the medication analogy again, the use of different forms of psychotherapy is similar to considering side effects in proscribing a particular medication.  If we know that two medications will work equally well to cure a condition, which should be employed?  The medication with side effects better tolerated by a particular individual would be the obvious choice.  For example, the new class of antidepressants called SSRI’s are very good, yet most cause serious reversible symptoms of sexual impairment.  If the patient is very sexually active, it might be better to use an older, though less effective, antidepressant without the unwanted sexual impairment.  Similarly, group psychotherapy is the most obvious choice to reduce social anxiety, yet initially it may be the worst form of treatment.  Exposed to the stimuli they fear the most, a group of people, the patient may experience recurrent trauma as a consequence of this treatment.  For this person, it is better to lessen the initial anxiety with individual psychotherapy, and then save the finishing touches for group psychotherapy.

The basics of psychotherapy are centered about confidentiality, a solid frame, and the identification of unwanted thoughts and/or behaviors.  The choice of which psychological technique to employ is similar to choosing amongst equally effective medications.  The choice of interventions should be based upon the comfort level of the particular patient, in light of their unique situation and lifestyle.

Is Alzheimer’s a Disease?

Is Alzheimer’s Disease truly a disease?  The word “disease” is defined as an “abnormal condition or illness” in the dictionary, and Wikipedia describes disease as “an abnormal condition affecting the body of an organism.”  The word shared in common between these definitions is “abnormal.”  What is labeled as “normal” or ” abnormal” is not a trivial distinction.  It encompasses much of the training I received towards becoming a clinical psychologist.  For something to be regarded as “normal” it must be observed to be the typical/common state of affairs.  This rests on the assumption that people are accurately and reliably able to distinguish between what is common and what is exceptional.  Where does one draw the line between the average and the exceptional?

Consider shoe sizes.  My feet are a size 12, and about 5% of males share this large size.  A size 12 foot is not the average for a male, but it is not uncommon.  The same size foot in a female is not average and it is fortunately uncommon.  What is considered or measured to be the average is highly dependent on the group being considered.  The deviation of my foot size from the human average increases when compared to females, Asians, and pygmy tribesmen-no relation is expressed or implied.  Though my feet are abnormal, they function quite well notwithstanding!  The notion of “normal” is an interval centered about the average of the population under consideration.  The notions of “normal” and “average” only have meaning in light of the specific population(s) being considered.  A statistical analysis may discover that male shoe sizes between 6 and 10 are within the “normal” range, whereas sizes less than 6 or over 10 are labeled “abnormal.”  The term “abnormal” should not be equated with the word “dysfunctional.”  An IQ of 130 is certainly abnormal, but definitely not dysfunctional.  These terms only have real meaning when nested within specific groups, defined by measurable functional outcomes that are evaluated over a finite period of time.

Most men are interested in enlarging their penis size Erectile dysfunction purchase female viagra affects one-third of men irrespective of age or race. Since different companies manufacture tadalafil best prices and cialis, these pills differ also in color, form and names. Decreased activity of mitochondria-specific proteins, including the transcription factor levitra free PGC1, a regulator of mitochondrial biogenesis, were also noted. One such issue which has bad effects later on is the dosage pattern which basically decides the after eating online viagra effects. So is a senile dementia of the Alzheimer’s type really a disease?  The quickest answer is that the biological process of Alzheimer’s is not a disease, but the end result of the process could be termed a disease.  All humans acquire neuritic plaques and neurofibrillary tangles as we cross the age 50 boundary.  Correspondingly, free verbal recall and naming decline with so-called normal aging.  The tangles and plaques are the organic hallmarks of Alzheimer’s Disease.  Less mentioned is that these tangles and plaques increasingly infest the brains of all middle-aged humans.  It is largely a question of degree.

Once the neurofibrillary tangles and neuritic plaques encompass about 30% of the cerebral cortex (brain’s outer coating of gray cells), the unfortunate person will exhibit the early symptoms of Alzheimer’s Disease.  Less than 30% of the cortical area manifests as “normal” cognitive decline, and over 30% of the cortex affected results in symptoms of early AD.  The organic pathology of AD is undifferentiated from normal aging until it is observed to cause functional impairment.  Even though the organic pathology is “normal,” the uncommon extent of the pathology and the unusual decline of mental skills could be termed a “disease.”  Similarly, all humans lose critical neurons that help us modulate and initiate motor movements as we age.  If more than 60% of these dopamine producing neurons are lost during our lifetime, we will exhibit the symptoms of Parkinson’s Disease.  Generally, under a 60% loss of the dopaminergic neurons will result in “normal” age-related tremors.  Once again the natural process of aging is labeled as a disease if its manifestation is unusually powerful and negative.  In the near future, I will address what people can do to minimize their chance of becoming “abnormal” in their old age.