Transcript the case for psychotherapy

BROOKHAVEN HOSPITAL
AUGUST 1, 2012
“THE CASE FOR
PSYCHOTHERAPY”
DENNIS CAVENAH, MS, LPC, LMFT, CEAP
THE CASE FOR PSYCHOTHERAPY
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Psychotherapy:
Licensed Health Care Providers:
Licensed Professional Counselors LPC
Licensed Behavioral Therapist LBP
Licensed Marital & Family Counselors LMFT
Licensed Social Workers LCSW
Licensed Alcohol & Drug Counselor LADC
MD Specialty In Psychiatry
RN with Psychiatric Training
THE CASE FOR PSYCHOTHERAPY
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Therapy & Your Brain:
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Involves the Limbic System & Prefrontal Cortex
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Limbic = memory & emotion
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Prefrontal Cortex = planning, judgment, selfcontrol
THE CASE FOR PSYCHOTHERAPY
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Psychotherapist Practice:
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Neuroscience?
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Rumpelstilskin Affect
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Voodoo?
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Witch Doctors?
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Shamans?
THE CASE FOR PSYCHOTHERAPY
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What psychiatric disorders benefit from
psychotherapy treatments??????
Phobias
 Obsessive-Compulsive Disorders
 Depression
 Bi-Polar Disorder (Whatever that means!!)
 Addictions
 Anxiety Disorders
 Panic Disorders
 Ptsd
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THE CASE FOR PSYCHOTHERAPY
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When are Antidepressants Better Than Psychotherapy?
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2005 DeRubeis et al., study of 240 patients:
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1. Pts. On Anti-depressant got better quicker.
2. Pts. Cognitive therapy worked as well as
antidepressant therapy on moderate to severe
depression.
3. @ 16 weeks 58% of both groups were better.
4. Pts. Who quit Paxil after 16 weeks relapse rate
twice that of psychotherapy patients.
5. Concluded psychotherapy more effective and less
costly in long run.
THE CASE FOR PSYCHOTHERAPY
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SSRIs vs. Placebo
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2005 Arrol et. Al., based on 15 studies concluded:
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1. Adults responded to 56% to 60% to
antidepressants.
2. compared to 42% to 47% for placebo.
3. 40% to 44% did not improve at all.!!!!!!
4. Concluded only 13 to 18% actually benefited from
antidepressant treatment.
THE CASE FOR PSYCHOTHERAPY
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2000, VHA-DOD; Veterans Health
Administration of Department of Defense.
1. Pharmacotherapy & psychotherapy
recommended for tx. of moderate to severe
depression.
2. Mild to moderate depression with a motivated
patient psychotherapy is warranted,
THE CASE FOR PSYCHOTHERAPY
THE CASE FOR PSYCHOTHERAPY
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1.
2.
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5.
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Effective Therapist Vs. Ineffective Therapists (?)
1. Professional training is of little importance.
2. Years of experience have little impact.
3. Little difference in theoretical training.
4. Have more positive alliance with their pts.
5. “Master Therapists”; emotionally receptive,
psychologically healthy, good relationship skills.
6. Some differences in understanding clinical
materials, greater complex cognitive skills, have
curiosity in difficult cases.
THE CASE FOR PSYCHOTHERAPY
The Psychotherapist as a Neuroscientist
A Safe and Emphatic Relationship
The Importance of Stress
The Importance of Language(co-construction of
narratives)
Language of Therapeutic Alliance:
1. Reflexive Social language.
2. Internal language.
3. Self-Reflection.
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THE CASE FOR PSYCHOTHERAPY
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The positive affects of psychotherapy on the
treatment of depression.
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Identify distorted thinking patterns.
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Understand everyday circumstances and events.
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Regain a sense of control and pleasure in life.
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Explore behaviors that might contribute to a low
mood.
THE CASE FOR PSYCHOTHERAPY
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Treatments for PTSD: returning soldiers, etc.
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Exposure Based Therapy
a)
a.
In Vivo-Imaginal Therapy
Systematic Desensitization
Cognitive Therapy
Anxiety Management Therapy
++EMDR vs. CBT
CBT significantly better treatment for PTSD (Deville &
Spence 1999)
THE CASE FOR PSYCHOTHERAPY
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1.
2.
3.
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Shared common feature of most psychotherapists
An office, designated to help with emotional
distress; i.e., “edifice complex,” diplomas etc.
The client and the therapist have well defined
roles.
A conceptual scheme or theoretical system to
explain a client’s suffering.
The therapists conceptual scheme which drives
the treatment procedure both participate in.
THE CASE FOR PSYCHOTHERAPY
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THE BUY IN
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1. Psycho-education.
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2. Define the diagnosis vs. the problem.
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3. Review the tx. Methods, referrals.
4. Coordination of care letter to other tx.
Providers.
 5. Written material to review.
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THE CASE FOR PSYCHOTHERAPY
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TRUTH OR MYTHS
Therapists can predict behavior.
 Therapists are experts.
 Therapists have inherit intuition.
 Therapists years of experience make them better.
 Therapist can use diagnosis and prediction for
future behavior.
 Licensing protects the public.
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THE CASE FOR PSYCHOTHERAPY
DEPRESSION FACTS:
 1. 4TH LARGEST MEDICAL PROBLEM IN THE
WORLD.
 2. TREATMENT COSTS ESTIMATED $50
BILLION
 3. 50% CTS. WITH SEVERE DEPRESSION DO
NOT RESPOND TO ANTI-DEPRESSANT
MEDICATIONS.
 4. MULTIPLE STUDIES INDICATE CBT
MORE EFFECTIVE THAT ANTI-DEPRESSANT
EVEN WITH SEVERE OR VEGETATIVE
DEPRESSION.
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THE CASE FOR PSYCHOTHERAPY
DEPRESSION FACTS:
 5. 1ST LINE TREATMENT FOR MOST PTS. IS
MEDICATION, RX. PCP.
 6. HIGHER RELAPSE RATE WITH THOSE TX.
WITH ANTI-DEPRESSANTS ONLY.
 7. AVERAGE LENGTH OF DEPRESSION
UNTREATED = 8 MONTHS.
 8. DEPRESSION IS NOT A RESULT OF
 “CHEMICAL IMBALANCE.”
 9. ANTI-DEPRESSANTS DO NOT TX.
DEPRESSION ONLY TX. SYMPTOMS.
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THE CASE FOR PSYCHOTHERAPY
10. RELAPSE RATE CONNECTED TO SIDE
AFFECTS OF MEDICATIONS.
 11.TAKES 6 WEEKS FOR MEDICATIONS TO
WORK MINIMUM LENGTH OF TX. WITH
MEDICATIONS IS 6 MONTHS.
 12. PTS. TX. ONLY WITH MEDICATIONS
HAVE A 80% CHANCE OF RELAPSE.
 13. COMBINATION OF PSYCHOTHERAPY
AND MEDICATIONS WORKS WELL WITH
SOME DEPRESSION.
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THE CASE FOR PYSCHOTHERAPY
References:
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Antonuccio, David O., Danton, William G., & DeNelsky, Garland Y. Psychotherapy Versus
Medication for Depression: Challenging the Conventional Wisdom With Data Professional
Psychology: Research and Practice. December 1995 Vol.26, No. 6, 574-585.
Kirsch I, Moore TJ, Scoboria A, Nicholls SS (2002) The emperor's new drugs: an analysis of
antidepressant medication data submitted to the U.S. Food and Drug Administration. Prev Treat.
5. article 23. Available: Accessed 15 July 2002.
Frank & Frank, “Persuasion and Healing, A Comparative Study of Psychotherapy, 3 rd Edition,
1993.
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Fancher, Robert T. Cultures Of Healing, 1995.
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Lilienfeld, Lynn, Lohr, Ed., Science & Pseudoscience in Clinical Psychology, 2003.
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Dawes, Robin, House of Cards, “Psychology & Psychotherapy Built on myth, 1996
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Cozolino, Louis, The Neuroscience of Psychotherapy, 2002
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Torrey EF. Witchdoctors and Psychiatrists - The Common Roots of Psychotherapy and Its Future.
revised ed. New York: Harper & Row, 1986.