Article of the Week: Week Eight

The first article I’d like to look at this week is from the excellent After Silence blog, which is about regaining one’s confidence, hope, life – one’s voice – after rape or sexual assault.  This particular entry discusses the physiological effects of post-traumatic stress disorder, which in the author’s case was of course caused by her own rape, but which is applicable to PTSD brought on by any type of trauma.

The author, Kimberley, discusses an article on the phenomenon from Pandora’s Project, which is a support site for those effected by sexual abuse (interestingly, ‘Pandora’ is the name currently leading my poll on what I should be ‘called’).  Firstly, Kimberley discusses the symptoms that are commonly seen in this illness, such as hypervigilance, flashbacks, severe anxiety and dissociation, though she then moves on to outline the biological research undertaken into PTSD.

The bottom line is this: PTSD is not just a psychological illness, but a physical one too.  Trauma does not just damage our psyche, it can actually change the physiology of our brains.  In particular, traumatic events seem to affect the hippocampus (a part of the brain that has responsibility for a lot of memory functions) and the medial prefrontal cortex (responsible for cognitive functions such as personality expression and decision-making).

I have come across information like this before, but Kimberley’s analysis of the Pandora article is worthy of particular note for her eloquence and understanding of this subject.

PTSD and Your Brain

Now, this I like.  Anyone who has followed this blog in the long-term knows about my complete disdain about all forms of cognitive behavioural therapy.  I think it’s the biggest pile of toss in the history of psychology, at least for people like me.  To say that I have faith in the psychodynamic and analytical schools of therapy would be false, because I am not sure that I really believe any form of psychotherapy works entirely.  Nevertheless, I hold the latter in much higher regard than the ‘newer’, in-vogue, supposedly cost-efficient therapies.

The problem in this position in the last few years has been that the psychodynamic schools have lacked empirically-based evidence for their effectiveness, whereas (surprisingly for me) CBT and its kindreds are backed by a myriad of studies supposedly supporting their effectiveness in treating various forms of mental illness and distress.

Well, finally it seems the psychoanalyst types have sought to prove the efficiency of their practice.  This article from Scientific American (reported prolifically elsewhere too) discusses a recently published journal article apparently demonstrating that psychoanalysis and psychodynamic therapy not only work, but keep working after cessation of treatment.

The piece claims that psychodynamic therapy has been shown in controlled trials to effectively treat anxiety, depression, eating disorders and, crucially for yours truly who is in psychodynamic therapy, personality disorders.  According to the author of the original journal article, this type of therapy enables patients to develop tools to better function in the “real world”, increases self-confidence and decreases the symptoms of their illness(es).  A key ingredient in achieving this is, of course, the therapeutic relationship.

Like the preceding article above on PTSD, there’s a wee bit of neuroscience thrown in here; current research seemingly suggests that psychodynamic therapy can produce changes in the prefrontal cortex of the brain, as patients begin regulate emotional health.

Naturally this isn’t a faultless paper; for one thing, the studies therein simply aren’t numerous enough in number.  But, not unsurprisingly in my view, most of the main detractors of the article’s findings are CBT devotees, who complain that this study is across various mental disorders, rather than focusing on just one.  Fair enough, but the analytic schools had to start somewhere (and admittedly should have done so sooner), and ‘somewhere’ is proving to be a promising start.

Talk Therapy: Off the Couch and Into the Lab

A few other articles of interest came up this week, but I think I’ve drivelled on enough.  Enjoy.  *coughs*

C is off tomorrow 😦  So I shall report on last week’s session then, hopefully.

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9 thoughts on “Article of the Week: Week Eight

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  4. All forms of therapy are under pressure to allow research into the ‘outcomes’ for their clients – it comes from the idea that mental health services can be based on ‘evidence-based practice’ in a similar way to other forms of medicine. CBT has had the advantage simply because it is a simpler form of therapy, and therefore easier to monitor. However, all the research mirrors the disputes which have existed since – well since Jung broke with Freud!

    No form of talking therapy has ever produced startling results – CBT gets the approval and funding because it is seen as the ‘best of a bad bunch’.

    What is new in therapy research is the attempt to show some lasting benefit – a year or more after sessions have ended. What puts it all in perspective is that it is of course never more than an hour and a half out of someones week.

    Finally, one finding which has been consistent to almost all studies, and is often quietly buried, is that the single most important factor effecting the outcome of any form of therapy is the personality of the therapist!

    (You said it was an effort knocking-out an ‘article of the week’, well sod it, live for the moment – I’ve got 14 unfinished posts/short articles in my documents!)

    • No form of talking therapy has ever produced startling results – CBT gets the approval and funding because it is seen as the ‘best of a bad bunch’.

      Yep absolutely, and furthermore it’s cost-effective (if one works under the assumption that it works, anyhow). I think that applies both to places like the UK where we have a public healthcare system, and to others like the US where insurance companies are the rulers of people’s healthcare. Because CBT is a relatively short-term form of psychotherapy, it ostensibly makes sense to provide it where possible to save cash. Problem is, it only ever treats outward symptoms of a psychiatric illness, totally ignoring any possible elements of causation, thus masking the depths to which the illness exists.

      What is new in therapy research is the attempt to show some lasting benefit – a year or more after sessions have ended. What puts it all in perspective is that it is of course never more than an hour and a half out of someones week.

      Well, quite. I find it absolutely startling that the amount of time that therapists – particularly but not exclusively in the NHS – allocate to each client is deemed remotely adequate. On the other hand, it is similarly startling that one can form an attachment to the therapist given such a measly period in one’s week…and yet here we have me, living proof of it!

      Finally, one finding which has been consistent to almost all studies, and is often quietly buried, is that the single most important factor effecting the outcome of any form of therapy is the personality of the therapist!

      Absolutely, and here is the only time you will see me defend things like CBT or DBT; the research consistently seems to suggest that in some ways, the actual type of therapy is not hugely relevant – it is one’s relationship with the therapist that is. Speaking personally, even seeing things from this perspective, I could still never see CBT working for me, as with trust issues like I have, the therapy just wouldn’t be funded for long enough for me to develop the necessary relationship with the psychotherapist. (But I can’t resist the dig that I wouldn’t be able to develop it anyway, even if it was in the long-term, as I can’t bear being patronised as I felt I was when I underwent CBT).

      You said it was an effort knocking-out an ‘article of the week’, well sod it, live for the moment – I’ve got 14 unfinished posts/short articles in my documents!

      Yeah, you’re absolutely right! I like to chronicle as much as I can here, but at the end of the day we can only exist in this one moment of time that we have, and if I can’t write, I can’t write! Though I hope that some time I’ll be able to read those 14 articles of yours 😉

      Take care Nick 🙂

  5. I too have my suspicions of all types of therapy, but I wouldn’t take the criticisms of CBT from a psychoanalyst any more seriously than from a layman…

    • Well, I can agree with that. The proponents of each type of therapy seem (in general) utterly opposed to all other types of therapy. To be fair to the article, though, it wasn’t particularly critical of CBT. No, that was me 😉

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