Category: Therapy

This is how psychotherapy for depression changes the brain

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Participants with major depression showed increased activity in left rostral anterior cingulate cortex following psychological therapy – see main text for details. Image via Sankar et al, 2018

By Alex Fradera

In recent years, researchers have sought to look under the hood to understand the neural correlates of the changes brought about by psychotherapy. Not only can such understanding help us hone in on the precise processes that are being acted upon in therapy, thus helping us focus on these gains, they could also show where pharmacological interventions might be complementary, and where they could directly obstruct the therapeutic work. Now a systematic review and meta-analysis in Psychiatry Research: Neuroimaging has outlined all we know so far about how therapy changes the depressed brain, and it suggests key changes occur in emotional processing areas.

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Interviews with 100 CBT-therapists reveal 43 per cent of clients experience unwanted side-effects from therapy

GettyImages-690819948.jpgBy Christian Jarrett

The structured nature of Cognitive Behavioural Therapy/CBT and its clearly defined principles (based on the links between thoughts, feelings and behaviours) make it relatively easy to train practitioners, to ensure standardised delivery and to measure outcomes. Consequently, CBT has revolutionised mental health care, allowing psychologists to alchemize therapy from an art into a science. For many mental health conditions, there is now considerable evidence that CBT is as, or more, effective than drug treatments. Yet, just like any form of psychotherapy, CBT is not without the risk of unwanted adverse effects.

A recent paper in Cognitive Therapy and Research outlines the nature and prevalence of these unwanted effects, based on structured interviews with 100 CBT-trained psychotherapists. “This is what therapists should know about when informing their patients about the upcoming merits and risks of treatment,” write Marie-Luise Schermuly-Haupt and her colleagues.

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Seven psychoanalytic psychotherapists reflect on the clients that didn’t get better, or even felt worse

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A key theme was that it felt like having just half the client in therapy

By Alex Fradera

Psychotherapists are devoted to improving people’s psychological health, but sometimes their efforts fail. A new qualitative study in Psychotherapy Research delves into what therapists take away from these unsuccessful experiences.

Andrzej Werbart led the Stockholm University research team that focused on eight therapy cases where the clients – all women under the age of 26 – had experienced no improvement, or in three cases, had deteriorated. This was based on comparing their pre- and post-therapy symptom levels following one to two sessions per week of psychoanalytically-focused therapy for about two years, to deal with symptoms such as depressed mood, anxiety, or low self-esteem.

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There are a lot of myths and misconceptions about Abraham Maslow and self-actualisation – a new paper puts the record straight

Abraham_Maslow.jpgBy Alex Fradera

Abraham Maslow was one of the great psychological presences of the twentieth century, and his concept of self-actualisation has entered our vernacular and is addressed in most psychology textbooks. A core concept of humanistic psychology, self-actualisation theory has inspired a range of psychological therapies as well as approaches taken in social work. But a number of myths have crept into our understanding of the theory and the man himself. In a new paper in the Journal of Humanistic Psychology, William Compton of Middle Tennessee State University aims to put the record straight.

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Does it matter whether your therapist is similar to you?

GettyImages-896857954.jpgBy Emma Young

How do you choose the best possible therapist for someone who needs help? Does it make any difference if the therapist is about the same age, for instance, or the same gender, or from the same socio-economic background? 

It seems intuitive that it might be easier to relate to someone from a similar background. However, while a positive relationship between client and therapist is known to be one of the most important factors for a good treatment outcome, there’s been surprisingly little work on how their respective personal attributes might interact to create a successful alliance.  

Now work led by Alex Behn, affiliated to both the Pontifical Catholic University of Chile and the Millennium Institute for Research in Depression and Personality, in Santiago, published in the Journal of Clinical Psychology, attempts to help plug that gap. 

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Psychotherapy trainees’ experiences of their own mandatory personal therapy raise “serious ethical considerations”

By Christian Jarrett

Many training programmes for psychotherapists and counsellors include a mandatory personal therapy component – as well as learning about psychotherapeutic theories and techniques, and practising being a therapist, the trainee must also spend time in therapy themselves, in the role of a client. Indeed, the British Psychological Society’s own Division of Counselling Psychology stipulates that Counselling Psychology trainees must undertake 40 hours of personal therapy as part of obtaining their qualification.

What is it like for trainees to complete their own mandatory therapy? A new meta-synthesis in Counselling and Psychotherapy Research is the first to combine all previously published qualitative findings addressing this question. The trainees’ accounts suggest that the practice offers many benefits, but that it also has “hindering effects” that raise “serious ethical considerations”.

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These are the therapist behaviours that are helpful or harmful, according to clients

GettyImages-594373291.jpgBy Christian Jarrett

Although psychotherapy is effective for many people, it doesn’t help everyone. In fact, in some cases it can do more harm than good. And while clinical researchers publish many studies into the outcomes of different therapeutic approaches, such as CBT or psychoanalytic psychotherapy, we actually know relatively little about the specific therapist behaviours that clients find beneficial or unwelcome.

A new study in the Journal of Clinical Psychology, although it involves only a small sample, has broken new ground by asking clients to provide detailed feedback on a second-by-second basis of their experience of a recent therapy session, and to explain their perspective on what took place. Intriguingly, the very same therapist behaviours were sometimes identified as helpful and at other times as a hindrance, showing just what a challenge it is to be a therapist.

“It is important to recognise that all therapists are going to make mistakes,” write Joshua Swift at Idaho State University, and his colleagues. “Perhaps the success of the session does not depend on whether errors are made but on the frequency of mistakes and how quickly therapists are able to repair them.”

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MDMA/Ecstasy may boost psychotherapy by increasing clients’ openness

GettyImages-488358430.jpgBy Christian Jarrett

Researchers reported recently that MDMA (3,4-Methylenedioxymethamphetamine; also known as Ecstasy) can act as a catalyst for psychotherapy, apparently improving outcomes for clients with previously intractable PTSD (post-traumatic stress disorder). Now a study from the same group in Journal of Psychopharmacology has uncovered what may be the key psychological mechanism: lasting positive personality change, especially increased trait Openness to Experience and reduced trait Neuroticism.

Speculating as to how MDMA might facilitate these trait changes, the research team, led by Mark Wagner at the Medical University of South Carolina, and including Ann Mithoefer and Michael Mithoefer who’ve conducted a lot of the recent pioneering research on MDMA-assisted psychotherapy, observed that “Qualitatively, a consistent subjective theme emerged, with our subjects reporting a profound cathartic experience, often described as going to a ‘place’ (in their mind) where they had never been before”.

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False economy? Half of “low intensity” CBT clients relapse within 12 months

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Low-intensity CBT can include group-guided self-help, computerised CBT and telephone support

By Christian Jarrett

Heralded as a revolution in mental health care – a cost-effective way to deliver evidence-based psychological help to large numbers – low-intensity Cognitive Behavioural Therapy (CBT) is recommended by NICE, the independent health advisory body in England and Wales, for mild to moderate depression and anxiety and is a key part of the “Improving Access to Psychological Therapies” programme in those countries. Prior studies into its effectiveness have been promising. However, little research has looked at whether the benefits last.

A new study in Behaviour Research and Therapy has done that, following a cohort of people with depression and anxiety over time. Disappointingly, the team led by Shehzad Ali at the University of York, found that after completing low-intensity CBT, more than one in two service users had relapsed within 12 months.

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Have we overestimated the effectiveness of psychotherapy?

By Christian Jarrett

Most people who undertake psychotherapy seem to benefit from it. How do we know? Arguably, the most important evidence comes from meta-analyses that combine the results from many – sometimes hundreds – of randomly controlled trials. Based on this, it’s been estimated that psychotherapy is effective for about 80 per cent of people (meanwhile, between five to 10 per cent of clients may suffer adverse effects).

But now the more concerning news: a team of researchers led by Evangelos Evangelou at the University of Ioannina, Greece has assessed the quality of 247 of these psychotherapy meta-analyses and they report in Acta Psychiatrica Scandinavica that many of them have serious methodological short-comings.

Coincidentally, a separate research group led by Brent Roberts at the University of Illinois, Urbana-Champaign has just published in Journal of Personality some of the first observational data on how people’s personalities change after undertaking psychotherapy. In contrast to what’s been found in the clinical literature, they report that people who’ve been in therapy seem to show negative changes in personality and other psychological outcomes.

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