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Psychotherapy
Written and researched by Bob Murray, PhD
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Elderly "Boot" Fido and Feel Better
December 2, 2002
Computerized "pets," such as those coming from Japanese electronics makers, could approach their flesh-and-blood counterparts in providing people with social interaction stimuli.
Purdue University is running a year-long study that puts an "AIBO" robot dog for six weeks in the homes of people 65 years and older who live alone, said Alan Beck, director of the Center for the Human-Animal Bond in Purdue's School of Veterinary Medicine.
Cats and dogs have the well-documented ability to improve patients' stress levels, blood pressure and other factors. Using robots could do the same while alleviating a medical staff's worries about possible animal drawbacks, such as the need for feeding and exercise, Beck said. "We want to see if robots can provide social stimulation in places such as assisted-living facilities and nursing homes. The robots have just enough movement and action to allow people to suspend their disbelief."
Using a robot also avoids the possibility of an animal being neglected or abandoned, Beck said. Although people have been suspicious of the idea at first, positive reactions have come quickly and strongly, Beck said. The first participant, in her 90s, started off thinking the robot's needs would include things such as batteries. After three weeks of hosting the AIBO, however, she said it needed attention and physical contact, Beck said.
"We're also finding people get so involved they start using the same pseudo-language with the AIBO that they would with real animals," Beck said. The robot spurs more person-to-person contact as well, with visitors such as grandchildren coming by more often, he said. The robot's programming introduces enough random activity to keep a person's attention, Beck commented. It can even provide mental stimulation, such as with a simple card game, that can alleviate feelings of isolation.
Anything that helps a lonely, disenfranchised elderly person must be something, I suppose. But must all relationships be sterile and controllable by the push of a button? AF
Read more in PsychPORT
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Couples Therapy Beats Antidepressants If One Partner is Critical
July 7, 2002
According to a study published in the British Journal of Psychiatry couples therapy is better and cheaper than antidepressants in preventing a relapse into depression if one of the pair has a critical personality. A team of British psychologists and psychiatrists set out to discover whether drugs or talk therapy were better for couples who suffered from depression. They were particularly interested in the drop-out rate and in the overall benefits of the two approaches. The study involved 77 couples where there was a history of depression and where one of the partners was critical. What they found was that the drop-out rate was higher for couples therapy (15%) but that talk therapy was more effective in both the medium and long term in alleviating depression. They concluded "For this group couple therapy is much more acceptable than antidepressant drugs and is at least as efficacious, if not more so, both in the treatment and maintenance phases."
Reported in the British Journal of Psychiatry
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Psychiatrists Bad at Relationships
November 26, 2001
Well, well! The psychiatric profession is finally beginning to come to terms with the fact that all problems cannot be solved by pharmaceuticals alone.
In an article in the current Psychiatric Times Paul Genova, MD, author of "The Thaw: 24 Essays in Psychotherapy" (Dorrance, 2000) writes "The mainstream of our profession has ceased paying much formal attention to the help our patients get from the doctor-patient relationship itself. But patients are stubborn. They still expect to have helpful relationships with us!"
Even in Australia and some other countries, where psychiatrists spend more time with their patients (at least their private patients), their competency in forming therapeutic relationships is not rated very highly.
Dr Genova gives a marvellous quote from an enthusiastic young colleague who was applying for a job in the same faculty Genova worked at. He was told that he might have to use psychotherapy and his reply was "Oh, like if there's time, you might do a little cognitive therapy on 'em?"
One of the problems is that the field of psychotherapy has become too narrow and too specialized with too many competing theories each proclaiming that they are the only valid one. Increasingly there are three opposing camps in the field of mental health: the pharmacologists (including most psychiatrists) who believe there is a drug solution for every complaint, the psychotherapists who often declare that pharmacology has no place and the neurologists who are broadening their world view of how the brain actually works on an almost daily basis, but who are ignored by both the pharmacologists and the psychotherapists.
Genova laments this non-meeting of minds. He asks: "What sense can we possibly expect our trainees to make of this Tower of Babel? Unless they are unusually persistent, they will either stick to the DSM (the official psychiatric diagnostic manual) and the meds and/or develop their own ways of conceptualizing personality and human nature, often with the help of pop psychology or New Age spirituality. In both cases, this dooms them to repeat sundry mistakes of the past, because an intellectually rigorous psychology of relationship, cognizant of boundaries and power arrangements, is missing. Should those of us psychiatrists who still try to teach psychotherapy in this inhospitable clime simply accept that the next generation will have to reinvent the wheel, or can we do any better for them?"
He suggests that the answer is to simplify psychotherapy and make it understandable to poor benighted trainee-psychiatrists. He's right, of course, but I doubt that American psychiatrists will be open to the length of time, empathy and intellectual rigor it takes to form a real therapeutic relationship.
Psychiatrists should learn the Fortinberry Murrary Method, which offers just such a comprehensive method of understanding personality and relationships. It is both simple and very effective. BM
Read more in the Psychiatric Times online
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New Study Points To Exercise And Therapy As The Cure For Chronic Fatigue Syndrome
October 7, 2001
A review which found that exercise and cognitive behavior therapy are the most effective treatments for chronic fatigue syndrome (CFS) is likely to split even further the two camps of patients, carers, and doctors who strongly disagree about the cause of the condition.
Simon Wessely, professor of epidemiological psychiatry at King's College, London, described the review as a "reasonable step forward that can help many people." But he added that the majority of the chronic fatigue syndrome community does not believe in the type of approach that was found to be the most helpful treatment option and would try to discredit the research.
Most sufferers and their vocal support groups argue that CFS is the result of a viral illness and that research should be focussed on finding a pharmaceutical cure. Their worry, especially in the US, is that insurance will not cover CFS if it is found to be the result of a mood disorder such as depression.
The review was conducted by two independent teams, one from the NHS Centre for Reviews and Dissemination at the University of York and another from the San Antonio Evidence-Based Practice Center at the University of Texas Health Science Center. It looked at 44 trials that included a total of 2800 patients. Overall, cognitive behaviour therapy (CBT) and graded exercise therapy (GET) showed the most promising results.
In an editorial accompanying the review, Professor Wessely wrote: "It is regrettable but likely that this review article will not be universally welcomed. Some consumers, and researchers alike, will make it their mission to discredit the authors and their conclusions. Others may see the findings, especially related to the benefits of CBT, as confirming their prejudices as to the mental instability of patients with CFS."
He added that "such views are misguided" but widespread among the public, health professionals and employers. Rather than argue about the cause of the condition the chronic fatigue syndrome community should, Professor Wessely said, build on the research by cooperating to perform more rigorous studies with more valid outcome measures than those used in the past.
"Despite years of trying we do not seem to be able to move away from the controversy that surrounds CFS and I have become depressed and despondent about the whole issue," he said. "People who have tried CBT and GET have high levels of satisfaction, but their availability within the NHS is pathetic and shameful."
The Fortinberry Murray Method uses 'somatic psychotherapy.' We stress the benefit of both exercise, particularly our Repatterning Movements, and talk therapy for a number of conditions, including CFS. BM
Read more in the British Medical Journal
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New Challenges to Psychiatry
September 4, 2001
The bible of psychiatrists and clinical psychologists is a tome called Diagnostic & Statistical Manual of Mental Disorders volume IV (DSM-IV for short). In this book are set out the symptoms that must be met for a diagnosis to be made, for an insurance claim to be met and for a person to be institutionalized -- perhaps against his or her will.
Now there is a movement within the psychiatric profession itself which claims that the whole system as laid out in DSM-IV (and earlier volumes I, II & III) is mistaken and that an entirely new basis for psychiatric definitions must be found. One prominent author goes so far as to say that the time has come for a new approach to the whole basis of psychiatry itself.
The less apocalyptic but still radical approach is to be found in an article in Psychiatric Research Report by Paul R. McHugh, MD, Henry Phipps Professor and chair of the Department of Psychiatry and Behavioral Sciences at the Johns Hopkins University.
According to Professor McHugh, modern psychiatry has become mired in a system of disease classification that defines mental disorders by the way they look and not on biological or psychological processes. The focus on symptoms, rather than psychologic or biologic foundations, has led to thousands of overlapping conditions and confusing diagnoses, and the current system has become unwieldy and outmoded, according to McHugh.
"The DSM-IV approach was a solution to problems of the past. It brought reliability to the diagnosis of mental disorders, but the solution to problems of the past has become the problem of today," said McHugh.
McHugh proposes that the fifth edition of the DSM, slated for 2007, incorporate a conceptual structure for psychiatry that seeks to identify the essence of mental disorders as expressions of psychological life in a context of pathology and misdirection.
This approach, used at Hopkins for over 20 years, is based on four explanatory methods or perspectives: disease, dimension or psychological variation, behavior and life story. In other words that the person be seen as more than just a collection of symptoms. That this, rather obvious conclusion, should have shaken the psychiatric world to it's foundations says a lot about the current state of psychiatry.
More revolutionary still are the 'postpsychiatric' ideas in a British Medical Journal article entitled "Postpsychiatry: a new direction for mental health" by Patrick Bracken, consultant psychiatrist and Philip Thomas, consultant psychiatrist at the Department of Applied Social Sciences, University of Bradford.
They believe that the whole way psychiatrists and clinical psychologists view people is outdated and mistaken. In particular they believe that modern psychiatry does not take cultural differences into account and is too bound up with an outdated 'institutional' approach to mental illness.
Postpsychiatry, in their view, emphasises social and cultural contexts, places ethics before technology (and drugs), and works to minimize medical control of coercive interventions. They believe that it gives the psychiatrist too much power to be able to commit a patient to an institution.
On a cultural level postpsychiatry opens up the possibility of working with people in ways that render the experiences of psychosis meaningful rather than simply psychopathological.
For example, the authors relate the story of a 53 year old married Sikh woman who had been hospitalized twice in the previous six years with a diagnosis of affective disorder. She was referred urgently by her general practitioner in July 1999, and when seen at home she was found to be excitable, over-talkative, irritable and was preoccupied with religion and past events in her life. Her family complained that she was overactive and spending excessive amounts of money. She was referred to Bradford Home Treatment Service where her key nurse, a Punjabi speaker, explored a number of issues with her and her family.
It emerged that the patient felt in conflict with her elderly mother in law, with whom the family shared the house. She believed that the elderly lady, who seemed to govern decisions about her grandchildren's forthcoming marriages, was usurping her position in the family. At the same time she had a duty of care to her mother in law, who suffered from diabetes and required her daughter in law's help to administer insulin. She also had a bond of loyalty towards her mother in law, which made it difficult for her to acknowledge the conflict, particularly outside the family.
With her nurse's support, the patient was able to produce her own interpretation of her psychotic behaviour:
- Overactive behaviour and spending excessively: to reclaim her role as mother and wife, to increase her contribution to family life, empowerment
- Overtalkative: seeking and demanding her husband's time when alone, need to discuss and influence family decisions, openly airing grievances
- Hostile, irritable: openly critical of family, challenging and retaliating, disagreeing
- Preoccupation with past: to contextualise grievances, add weight to her argument, and elicit understanding
- Religious preoccupations: to renew her strength, a way of coping with stress, a focus in her life.
Framing her problems in this way rather than in terms of a medical diagnosis allowed a space in which these issues could be explored gently with the patient and her family. Her husband became more accepting of his wife's grievances and her behavior. She has stayed well over the past 12 months, needing no drugs.
As the authors state, postpsychiatry frames the issue of mental illness in a different way. It does not propose new theories about madness, but it opens up spaces in which other perspectives can assume a validity previously denied them. Crucially, it argues that the voices of service users and survivors should now be center stage.
Now that would be new. BM
Read more from Johns Hopkins University
Read more in the British Medical Journal
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Hypnotherapy May Not Work To Recover Lost Memories
September 4, 2001
A new study suggests that hypnosis doesn't help people recall events more accurately -- but it does tend to make people more confident of their inaccurate memories.
Researchers asked college students, including some who were under hypnosis, to give the dates of 20 national and international news events from the past 11 years. Those who were hypnotized were no more accurate than others in choosing the correct dates. However, those who were hypnotized were more reluctant to change their answers when they were told they might be wrong.
The results suggest that people may have too much faith that hypnosis can help them accurately recover lost memories, said Joseph Green, co-author of the =tudy and associate professor of psychology at Ohio State University's Lima campus.
"Clearly, myths and misconceptions about hypnosis abound," Green said. "While hypnosis does not enhance the reliability of memory, there is some evidence that hypnosis leads to increased confidence in memories."
These results support earlier survey research co-authored by Green that found nearly nine of ten people in four countries believe that hypnosis can help someone remember something that they could not remember otherwise.
Green conducted the latest study with Steven Jay Lynn of the State University of New York at Binghamton. The study involved 96 college students who were asked to give their best estimate of the day, month and year that various events occurred. These included the date the Gulf War began, the day a bomb exploded in Atlanta during the Olympics and the date that Kurt Cobain of the rock band Nirvana committed suicide.
About half the students were hypnotized before performing the task, while the other half performed a progressive muscle relaxation exercise.
In addition to giving dates, the students were asked to rate how confident they were in the estimates they gave. Afterwards, the booklets with the date estimates were collected.
After 20 minutes, the students were told the booklets had been scored to determine if their dates were within three months of the actual date. All participants were told that if they had a red star on the back of the booklet, at least one, but maybe more of the dates were inaccurate. In fact, though, the researchers had put red stars on all the booklets. The students were then given 10 minutes to review and change any of their previous estimates and give new ratings of how confident they were of their date estimates.
Results showed that the students who were hypnotized were no more accurate than those in the relaxation group. On some of the questions, none of the students were within three months of the correct date. At best, 62.5 percent were within three months of the correct date of an event.
In their ratings, the students who were hypnotized were no more confident of their date estimates than were the other students, Green said. However, participants who were hypnotized were less likely to change their estimates when told some were wrong.
Participants in the hypnosis group changed only 16.9 percent of their answers, compared to the other group, who changed 24.6 percent of their answers.
The fact that students under hypnosis said they were no more confident of their answers than did others, but were still less likely to change their answers, suggests the belief in the power of hypnosis to improve memory operates outside of conscious awareness. "Those who were hypnotized tell you they are not confident in their answers, but their behavior -- the reluctance to change their answers -- suggests they must be more confident in their answers," Green said.
The reason may be the myths that surround hypnosis, he said. "It's widely believed that hypnosis somehow acts as a truth serum, that it unlocks memory and permits people to perform mental operations that they otherwise couldn't do," Green said.
I am suspicious of any technique which seeks to 'recover' lost memories in an artificial way. What people 'discover' under hypnosis is often what they believe the therapist, as the parent-authority figure wants to hear. This is how 'memories' of past lives are 'recovered.' For more about false memories see our health news story
"False Memories Easily Created". BM
Reported in Uniscience
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'Dream Therapy' Helps Rape Victims
August 8, 2001
Researchers say "image rehearsal therapy" greatly improved the amount of sleep that women were able to enjoy. Traditionally, even though women with post-traumatic stress disorder following rape or sexual abuse do suffer nightmares, doctors tend to treat other symptoms of the disorder rather than focus on the nightmares themselves.
However, Dr Barry Brakow and colleagues at the Sleep and Human Health Institute in Albuquerque, New Mexico, looked at a group of 168 women, most of whom had suffered a rape or serious sexual assault. Most had also been repeatedly abused as a child or adolescent. Instead of only dealing with other symptoms, such as depression or intrusive thoughts, Dr Brakow coached the women in "dream therapy".
This involved thinking of pleasant images, then thinking of the type of nightmare they might suffer, and imagining or visualizing a different, more pleasant, outcome or ending. Then this new "nightmare" was rehearsed mentally for between five and 20 minutes a day. Many of the women found that not only were their nightmares less frequent, but that overall their sleep improved and other post traumatic stress symptoms got better as well.
Dr Brakow said: "Perhaps by decreasing bad dreams and improving sleep quality, post-traumatic stress disorder patients improve daytime energy, which facilitates coping with other distress symptoms."
I have been using this therapy to treat depression and PTSD for some time. The causal link between sexual abuse and depression and PTSD is very strong and this kind of dream therapy is, I have found, very effective in dealing with both disorders. BM
Read more on BBC News
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False Memories Easily Created
July 2, 2001
Real, accurate, memory lasts for about 45 minutes. After that 'memories' are filtered through what we call the 'program' of beliefs and experiences that we have built up from earliest childhood. Often we 'remember' things that never happened or seek explanations and contexts for fragments of memory for which we have none.
In this way a young child's traumatic and fragmentally-remembered hospital visit can become a 'memory' (fervently believed) of an alien abduction. The child is forcibly removed from its parents for painful procedures and the gleaming operating theater with its frightening machines and masked and green-robed denizens is remembered as the abductors' space ship.
Now research has shown that faulty memories can be created in the adult brain from mis-matched fragments and can be a very powerful advertising tool. Just how effective this can be was demonstrated in an experiment conducted by University of Washington memory researchers Jacquie Pickrell and Elizabeth Loftus.
They found that about one-third of the people who were exposed to a fake print ad describing a visit to Disneyland and how they met and shook hands with Bugs Bunny said later they remembered or knew the event happened to them. The scenario described in the ad never occurred because Bugs Bunny is a Warner Bros. cartoon character and wouldn't be featured in any Walt Disney Co. property.
"The frightening thing about this study is that it suggests how easily a false memory can be created," said Pickrell. "It's not only people who go to a therapist who might implant a false memory or those who witness an accident and whose memory can be distorted who can have a false memory. Memory is very vulnerable and malleable. People are not always aware of the choices they make. This study shows the power of subtle association changes on memory."
In the new research, Pickrell and Loftus divided 120 subjects into four groups. The subjects were told they were going to evaluate advertising copy, fill out several questionnaires and answer questions about a trip to Disneyland.
- The first group read a generic Disneyland ad that mentioned no cartoon characters.
- The second group read the same copy and was exposed to a 4-foot-tall cardboard figure of Bugs Bunny that was casually placed in the interview room. No mention was made of Bugs Bunny.
- The third, or Bugs group, read the fake Disneyland ad featuring Bugs Bunny.
- The fourth, or double exposure group, read the fake ad and also saw the cardboard rabbit.
30 percent of the people in the Bugs group later said they remembered or knew they had met Bugs Bunny when they visited Disneyland and 40 percent of the people in the double exposure group reported the same thing.
"'Remember' means the people actually recall meeting and shaking hands with Bugs," explained Pickrell. "'Knowing' is they have no real memory, but are sure that it happened, just as they have no memory of having their umbilical cord being cut when they were born but know it happened.
"Creating a false memory is a process. Someone saying, 'I know it could have happened,' is taking the first step of actually creating a memory. If you clearly believe you walked up to Bugs Bunny, you have a memory."
In addition, Pickrell said, there is the issue of the consequence of false memories, or the ripple effects. People in the experiment who were exposed to the false advertising were more likely to relate Bugs Bunny to other things at Disneyland not suggested in the ad, such as seeing Bugs and Mickey Mouse together or seeing Bugs in the Main Street Electrical Parade.
"We are interested in how people create their autobiographical references, or memory. Through this process they might be altering their own memories," Pickrell said. Nostalgic advertising works in a similar manner. "Hallmark, McDonald's and Disney have very effective nostalgic advertising that can change people's buying habits. You may not have had a great experience the last time you visited Disneyland or McDonald's, but the ads may be creating the impression that you had a wonderful time and leaving viewers with that memory. If ads can get people to believe they had an experience they never had, that is pretty powerful."
This research is a strong argument against therapists who relentlessly hunt for a specific occurrence in early childhood even though the client can't remember it or who suggest to their client that they might have been 'sexually abused' in some way. The brain will often manufacture a 'memory' to satisfy the therapist. Fortinberry-Murray practitioners (we provide professional training in the FM Method) are well aware of the somatic and behavioral traits which may indicate early abuse. However, they also keep in mind the malleability of memory and that the solution to problems created by that abuse lies in getting needs met in the present. BM
Reported in Uniscience
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Rebirthing Therapy Can Be a Killer!
April 28, 2001
A year ago a 10 year-old girl, Candace Newmaker, died during a rebirthing therapy session. Now Colorado, the state in which she died, has banned the practice.
The rebirthing therapy has become popular in recent years as a way of treating a variety of emotional and psychiatric disorders. The idea is to alleviate the patient's symptoms by re-creating the birthing experience. In the case of Candace Newmaker the therapists were, allegedly, trying to cure her of Reactive Detachment Disorder, a psychiatric illness thought to be caused by the failure of normal bonding with a parent or carer during infancy.
Candace died after she was wrapped from head to toe and surrounded by pillows. Despite the girl's cries that she was suffocating, the therapists continued to push her in an attempt to simulate uterine contractions. The therapists were convicted of reckless child abuse resulting in death and sentenced to 16-48 years' imprisonment.
We have often been called to treat victims of rebirthing therapies of various kinds. My own feeling is that, as practised by some people, it is a misguided, dangerous and ineffective treatment. BM
Read more on the British Medical Journal
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Dr Rex to the Rescue
December 27, 2000
A piece on CNN news recently reported that more and more hospitals in the US are enlisting canine consultants to help them work with patients. Though it has been =ell-known that ownership of a pet can greatly increase your emotional and physical health there have been few studies showing the effects of allowing animals in hospital wards. Now evidence is coming in that animals can greatly speed-up the recovery process in hospitals.
From a medical standpoint, there are two types of animal/human interaction -- animal visitation and animal-assisted therapy. Animal visitation can include almost any pet -- furry or feathered -- and is usually an informal visit. While there are generally no firm medical goals, patients may experience benefits like lowered blood pressure, lowered blood sugar and improved physical movement. Animal-assisted therapy, by contrast, pairs a well-trained, certified animal -- usually a dog -- with an experienced handler and a medical team that includes a physical therapist. Specific medical goals are set for each session and records are kept to chart any improvements.
Dogs are particularly useful in helping with stroke victims. When working with a stroke victim with left-side partial paralysis, for example, specific patient goals can be given, such as sitting up, standing and memory recall. Perhaps the handler might bring the dog to the patient on the left side so he/she is motivated to reach out with the left hand to pet the animal. Then the handler might tell the patient facts about the animal -- its name, age or favorite food. Several minutes later the patient could be asked to recall the information -- an exercise that helps the medical team assess mental abilities.
Dogs are cheaper than doctors, are better at relationships and aren't the target of liability lawyers.
To find out more about animal assistance therapy programs, such as the Upper Michigan Dog Therapy Project, refer to the article of December 27th 2000, on CNN News.
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About the Author
Dr Bob Murray is a widely published psychologist and expert on emotional health and optimal relationships. Together with his wife and long-term collaborator Alicia Fortinberry, he is founder of the highly successful Uplift Program, and author of Raising an Optimistic Child (McGraw-Hill, 2006) and Creating Optimism (McGraw-Hill, 2004).
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