Sunday, May 13, 2007

A Series of Posts on Psychotherapy

I'm going to begin a series of posts on psychotherapy, which are long overdue. When I started blogging, I anticipated writing a lot about the science of psychotherapy, but I haven't followed through with it; I've been having too much fun with other things.

Two events have come together to get me started. First, at Aardvarchaeology (on ScienceBlogs), there was a recent post entitled, Is Psychotherapy Superstition? in which the author, Dr Martin Rundkvist, seemed to be confused about what psychotherapy is. Furthermore, some of the commenters on the blog seemed totally unaware of the evidence for the effectiveness of psychotherapy.

Second, I put off a post on a story in last week's New York Times Magazine by Bruce Stutz, who decided to withdraw himself from Effexor. Stutz initially went on Effexor after becoming depressed during difficult period in his life. He stayed on the drug for several years, and was advised to stay on it the rest of his life. He decided that he didn't want to and weaned himself off, but experienced severe withdrawal symptoms in the process:

Over the next several days they (low doses of Effexor--F.O.) came in handy, especially at night, when I would wake up feeling dizzy, almost seasick, disoriented and in a heavy sweat, the pillow soaked. One night, awake and not eager to go back to lying restlessly in bed, I went online, typed in “Effexor withdrawal” and found bulletin boards full of pained, plaintive and sometimes angry posters who had quit taking their medication and were suffering a broad but surprisingly consistent range of symptoms: dry mouth, muscle twitching, sleeplessness, fatigue, dizziness, stomach cramps, nightmares, blurred vision, tinnitus, anxiety and, weirdest of all, what were referred to as “brain zaps” or “brain shivers.” While there were those who went off with few or no symptoms at all, others reported taking months to feel physically readjusted.
Stutz eventually did wean himself off Effexor, and has not had a recurrence of depression. He puts his finger on the issue:
If my psychiatrist had told me, “I think you can do this without taking any drugs,” would I have done just as well? If I had been told how difficult it would be to get off the drug, would I have so readily started on it? Even the doctors and researchers who most believe in the effectiveness of antidepressants acknowledge that the “chemical balance” paradigm, the magic-bullet paradigm, makes things seem simpler than they actually are. For some, these drugs may be a lifesaving treatment. But for most of us troubled or even temporarily anguished by life’s difficulties, does our long-term reliance on these drugs become more of a convenience than a cure, allowing us to simply keep going in the midst of very difficult circumstances? And once we start taking them, how do we find the wherewithal to stop?
To make a decision between drugs alone, psychotherapy alone, and both combined, patients need to understand what psychotherapy is. It is not a panacea, as it was once advertised. It's not for all people, or even for all depressed people. Prospective clients of a psychotherapist need to understand what they are getting into. So, there are three topics I want to address in this series.

First, I'll talk about what psychotherapy is and is not. To do that, I have talk about the history of psychotherapy and how we got to where we are today. Next, I'll give a brief description of research in psychotherapy, and finally, I'll talk about how therapy and medication work together in treatment.

I hope this will give readers a better idea of what to expect if they seek psychotherapy and a better ability to understand some of the stories about the effectiveness of therapy that emerge in the press. All treatments for physical and mental illnesses involve decision making. The more you understand the options, the better.


BenP said...

I'll do the almost the same thing in french on my blog ! I'll pick some inspiration here.

Alan said...

I'm looking forward to the series. I have to admit that I can't describe psychotherapy, and hope to get some good, solid information from this.

Anonymous said...

I'm considering my options for training and have learned that some psychologists have written books complaining about how when thrown in actual counseling situations, their psychological training and theories didn't have any bearing on the situations they faced.

Would you mention these resources if you know of them so I can learn what to seek and what to avoid?

Free Operant said...


I don't know what books you are referring to. I'm sure there are some, however.

I have mixed feelings about the issue. My degree is a Ph.D. and I believe that the scientific training I got was invaluable. I probably would have benefited from more clinical training in the early part of my career, though.

The best training you get in clinical work is hands-on training. So, I'd suggest that you carefully evaluate the training program in terms of practicum experience. The more practicum training, the better, within obvious limits.

Training in science and the theoretical aspects of clinical work is still important. I guarantee some nonsensical therapies will surface in your career. Being able to evaluate the evidence will help you recognize it and you'll really appreciate the scientific training.

Another thing to keep in mind: The exam for licensure of clinical psychologists is heavily oriented to research. I've seem people fail that exam 5 times (!) because they had poor grounding in science.