Tag Archives: Analyst

Swedish National Audit Office report on CBT

Swedish National Office Report on CBT

In a study of the outcomes of using CBT as a primary and almost exclusive method of treating mental health issues such as depression and anxiety, the Swedish National Office has published a damning report. See here

Main findings of report on CBT

  •  The widespread adoption of the method had no effect whatsoever on the outcome of people disabled by depression and anxiety;
  • A significant number of people who were not disabled at the time they were treated with CBT became disabled thereby increasing the amount of time they spent on disability; and 
  • Nearly a quarter of people treated with CBT dropped out.
    From Swedish Audit Report. accessed HERE

Application and conclusions in the UK

CBT or cognitive behavioural therapy is the darling of the NHS, many charities and NICE. This is primarily because it claims to be evidence based.

CBT leads itself to being “evidenced based” through gathering self assessed feedback from clients. This is unreliable for a whole range of reasons, including:

  • Subjective self assessment does not permit one controlled stand across subjects. Introspective grading of experience is not possible.
  • Assessment reduces responses down to highly simplistic responses, often statistics and does not reflect human experience or allow for situational or environmental difference.
  • There is an influence on “wellbeing”, “getting well” or feeling “happy” when therapy is not always about these, we often feel “unhappy” for good reason”.
  • CBT often plays into the biomedical model of being “sick” and needing to feel happy despite this, rather than considering other explanations for symptoms such as psychodynamic, cognitive behavioural analysis, developmental or humanistic explanations or social and environmental causes / factors.
  • CBT is often highly simplistic. It has been termed “the art of the blindingly obvious” since it often leads subjects through exercises that reveal what they already new, providing little empowerment for change.

Illogical to use one method

Reducing provision down to one method is akin to only using one class of medical drugs, it simply does not make sense. Clients are complex and unique individuals going through a unique combination of social, biological, psychological, interpersonal and developmental processes, any of which alone may seem common or typical, but which form a vast array of potential combinations.  With that variety and complexity, thinking “one size fits all” is simply illogical.

Furthermore CBT is a simplistic method formed out of other methods, making it a method within an array of methods. For example it was developed in response to psychodynamic and humanistic thinking, and provoked revised psychodynamic, humanistic and cognitive behavioural analytic thinking. It makes no sense to home in on one incomplete stage of the ever changing face of psychological therapy and prioritise it at the expense of other methods.

Its just a tool (CBT)

Cognitive Behavioural Therapy is just ONE tool in the toolbox of multi-skilled psychotherapists.  Many therapists use CBT when it is appropriate, but “if all you have is a hammer, all you see is nails”. Why would anyone throw away all the other tools.

Integrated work for the unique client

Stuart uses CBT where appropriate, along with the deeper and more complex Cognitive Behavioural Analysis methods (including CBASP for long term depression). Stuart also uses psychodynamic psychoanalysis, humanistic and philosophical psychotherapy, mindfulness and clinical hypnotherapy. The approach is integrated and employs a kind of critical psychotherapy, in other words questioning what the outcome “should” be, and working with the client to determine what their desired outcome is going to be. Therapy is then tailored, incorporating methods such as CBT, CBA, IPT and psycho-education with research evidence and NICE recommendation behind them.

Key Words
CBT Cognitive Behavioural Therapy, Cognitive Behavioural Analysis, CBASP, Psychotherapy, Psychoanalysis, Psychodynamic therapy, Counselling, Psychology, Psychotherapist, Counsellor, Psychoanalyst, Analyst, Hypnotherapist, Mental health, Depression, Anxiety, Personality disorder, Edinburgh, Falkirk, Stirling

Contact via the contact us page HERE

 

 

Dis-associative Disorders

Psychological therapy for Dis-associative Disorders

Dis-associative disorders are conditions where the sufferer dis-associates for periods of time. What this means in basic terms is they mentally “switch off” or “blank” in a way that may either appear to be day dreaming, or which may just resemble a silent few moments. In more severe cases two other presentations may occur: dis-associating into a different personality, or with a loss of consciousness.

Short blank disassociations

This is the most likely version to be seen, the person reacts to stress or an anxiety trigger by “being elsewhere”. it can also be the result of a flash back being triggered where a historical event is being recalled. The person may appear inattentive, distance, and seem to be ignoring you. This can lead to misunderstanding, conflict and accusations of laziness or inattention, especially in adolescents in education or when it occurs in the workplace. Depending on whether a task is under way at the time, it is possible for this task to be interrupted for a moment, or even, for example, for a cup of tea being made to be split or dropped.

It should be noted that it is very hard to tell these short blanks apart from epileptic “absence” seizures and  it is important to discuss them with your medical doctor and not assume they are psychological in nature.  It should be remembered however that it is more usual for psychological disassociation to be misdiagnosed as epilepsy.

Personality change disassociation

In more severe cases the personality of the sufferer undergoes a change in the disassociated state and a person may appear to have changed in their behaviour, attitude and even in what they believe and remember. What occurs in this state may not be remembered afterwards.

It is a matter of debate whether this is related to schizophrenia or not,  with some sufferers of disassociation adamant that it is a different condition entirely, and some sufferers of schizophrenia claiming that their condition is itself a form of disassociation.

Loss of consciousness disassociation

Often called Non Epileptic Attack Disorder (NEAD) or pseudo-epilepsy,  this is the ultimate disassociation response. The person will loss consciousness and will often shake or spasm as one would expect to see in epilepsy. NEAD is often initially misdiagnosed as epilepsy.

Most people are aware of flight and fight responses to danger. The third response however is that seen in the humble possum. The person loses consciousness, lies still playing dead, the body is flooded by natural pain killers, and for the predator the sufferer / possum appears to be a long dead and unpalatable prey. This state is often associated with loss of bowel or bladder control, again to make the prey smell “off”.  This is a highly primal response to extreme danger.

Causes of disassociation

Disassociation occurs when the sufferer has a history of being faced by traumas such as abuse or rape which can not be coped with at their mental state or age. Thus it is common for these conditions to be present in adult survivors of child sexual abuse or domestic violence. Essentially the subject learns to “opt out” of the situation they are incapable of handling.

Treatment of disassociation

There are two main strategies for addressing disassociative disorders:

1. Increase the sufferer’s ability to cope with stressful situations. This may involve cognitive behavioural therapy to reduce stress response with methods like stress inoculation therapy. It may also involve analysis of interpersonal relationships to adjust perceptions and behaviours which may otherwise lead to conflict. Interpersonal psychotherapy methods, CBASP, CAT or other analytic cognitive behavioural methods might be employed. This is therefore an attempt to use psychoeducation and personal analysis to better manage the condition day to day.

2. Addressing any history of abuse. Addressing PTSD (post traumatic stress disorder) as a condition may reduce the underlying effects presented as a disassociative disorder. Psychoanalysis, cognitive behavioural analysis, trauma debriefing such as specialist hypnotherapy “trauma runs” can all be used if appropriate.

Co-morbid presentation

It is common for persons with disassociate disorders to have a history of different diagnosis, and to have elements of different mental health conditions. These might include depression, anxiety, self harm, mood disorders or OCD.

Key words
Disassociation, disassociative disorder, disassociative seizures, NEAD, non epileptic attack disorder, possum response, flight and flight, PTSD, post traumatic attack disorder, sexual abuse, domestic violence, survivor of childhood abuse, child abuse survivor, personality change, mood change, mood disorder, anxiety, depression, OCD, self harm, multiple personalities, multiple personality disorders, loss of memory, stress response, psychotherapy, psychoanalysis, cognitive behavioural analysis, cognitive behavioural therapy, CBASP, CBT, hypnotherapy, counselling, psychotherapist, psychoanalyst, analyst, hypnotherapist, couhsellor, therapy, therapist, psychology, psychologist, Edinburgh, Glasgow, Falkirk, Stirling

Contact via the contact us page HERE

 

The Narrative in psychoanalysis

Using the narrative in psychoanalysis and psychotherapy

The narrative, or the story being followed and invested in by the client is a concept often associated more with humanistic psychology and positive psychology because of it’s connection with eastern psychology. However the narrative can link very well to psychoanalysis.

Who am I, what is my archetype?

The archetype is sometimes the ideal person or concept that we strive to be. In his Red Book, Jung refers to having to slay the blond warrior and allowing oneself to become the authentic person. More generally the archetypes that correspond in our unconscious minds to ourselves and other key players in our lives are crucial to the make up of the narrative we follow.

The Lacanian mirror

To paraphrase the Lacanian idea, essentially there are three versions of us –  the real us, who we are pretty much unaware of because we are not happy with it, the ideal us or “super-me” who is perfectionism embodied (and who corresponds in many ways to an archetype) and the mirror image who we see of ourselves in the eyes and reactions of others.  Our narrative becomes focused on trying the third “me” to look like the “super-me” and this becomes a main part of the narrative.

The negative Narrative

In CBT having a negative narrative is often referred to as catatrophising. We ask “what if” repeatedly until we end up with disaster. “what if I get an unexpected bill, then what if I go overdrawn, then what if the rent check bounces, then what if my home is repossessed and I am living on the street with addiction issues”.  What often happens is we approach a problem with the expectation that something bad will happen, then we become anxious and tense in anticipation, creating anticipatory anxiety.

Having a positive anticipation looks completely different.  As a respected colleague John Parkin suggests in his mindfulness based teachings, what if you approach the problem with the idea that it will be really easy and straightforward. The first answer is –  no anticipatory fear and anxiety to make you freeze up or become stressed. The second answer is that you will approach it in an optimum state of calm preparedness –  flexible and calm, ready for anything even if things are not 100% perfect.

Object relations, the Kleinian model of relationships and our interactions teaches us about many of the problems with feelings of rejection, abandonment and conflict. The lessons we learn through these experiences often influence how we perceive and anticipate events, especially when they involve interacting with people.

Creating your own narrative

Creating your own narrative, and having the realisation that you have every right to create your own narrative is a very empowering concept. The narrative needs to focus as much as possible on the “real me” which in Lacanian theory we tend to suppress, enabling the concept of “authenticity” as much as possible. This means that we have an authentic concept of ourselves, and life around us, but have the courage to write the script of how that interaction might turn out. Using this model, and other techniques alongside it, the client can learn to make positive and proactive choices, reject old conditioning from others, and become aware that they are “good enough” –  neither “flawed”, nor destined to strive for “perfectionism”.

Psychoanalysis in Edinburgh, Falkirk and Glasgow

Stuart trained in psychoanalysis and clinical hypnotherapy from 1993-1996 with over 200 assessed cases (over 1,000 client hours) and external assessment via the NVQ system. He graduated in 1996 with a diploma in analysis and hypnotherapy and an NVQ Level 4 Training and Development. Since graduation he has completed CPD training in a range of other models of psychotherapy, counselling, coaching, NLP and mental health, along with a MSc Psychology.