Tag Archives: cognitive behavioural analysis

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

Professional Standards Authority Accredited Registers

Professional Standards Authority Accredited Registers

 

The PSA has launched a report on the new Accredited Registers that list professional healthcare personnel not subject to Statutory regulation. Accredited Registers are professional registers that meet the stringent PSA standards for professional practice. They include registers for complementary therapists and holistic therapists such as the CNHC, NHS (hypnotherapy society) and FHT, and registers for counsellors and psychotherapists including the BACP, COSCA and UKCP.

Real standards, real contribution to health

The report discusses the real standards required to be registered on an AR, standards that protect the public and ensure quality has been checked.

The report also concludes that the AR registers must play a vital role in the provision of integrated healthcare in the UK

Accredited registers in our psychoanalytic practice

 

Both of our practitioners, Denise and Stuart are registered on both the CNHC and FHT Accredited Registers under the hypnotherapy category. The CNHC representatives on the 13th March 2015 at the meeting in Edinburgh confirmed they recognised that counselling and analysis were vital job functions for hypnotherapists and delegates commented that hypnotherapists virtually always provided these additional therapies.

Stuart and Denise are registered with the Society of Stress Managers, a professional body representing Analysis, Stress counselling and Hypnotherapy, and the National Association of Counsellors Hypnotherapists and Psychotherapists, both of which are CNHC accreditation routes. Although they use the titles of Analyst and Hypnotherapist, naturally psychotherapy and counselling are within their job functions, and as such they are registered and insured for these as well. Notably both therapists have received specific training in counselling, psychotherapy (including CBT), life coaching and psychology.

REPORT HERE

Key words
Professional standards authority, professional therapists, psychotherapy, counselling, hypnotherapy, psychoanalysis, analysis, CBT, cognitive behavioural analysis, Edinburgh, Falkirk, Stirling, life coaching, regulation