By: Joe Hitchcock,
on 2/5/2016
What happens in our relationships? This is the question that draws people into the profession of couple therapy. Therapists stand outside the couple in order to understand how their relationship systems and unconscious dynamics work. What is it that the couple have created between them? How can you restore the balance within that relationship?
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By: KatherineS,
on 8/14/2015
Daniel Pick, author of Psychoanalysis: A Very Short Introduction, introduces psychoanalysis, discusses its role within history and culture and tells us how psychoanalysis is used today. How has psychoanalysis developed from the late nineteenth century?
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By: Rebekah Daniels,
on 7/30/2015
When I meet with patients newly diagnosed with cancer, they often find it difficult articulate the forbidding experience of being told for the first time they have cancer. All they hear is ‘die’-gnosis and immediately become overwhelmed by that dreadful feeling: "Oh my God, I’m gonna die!" I often try to meet them in that intimate and vulnerable moment of existential shock and disbelief by stating, "It’s like being hit by an existential Mack truck."
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By: VictoriaD,
on 7/30/2015
We're excited for the upcoming annual conference of the American Psychological Association in Toronto, Canada this year from 6-9 August 2015. The conference will be held at the Metro Toronto Convention Centre. The annual convention of the American Psychological Association is the largest assembly of psychologists and psychology students in the world.
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By: ChloeF,
on 2/20/2015
The 20th century has been called ‘the century of psychiatry’, and in many ways one could read that as ‘the century of psychotherapy’. A hundred years ago, at the onset of World War I, psychotherapy had touched the lives of only a tiny number of people, and most of the population had simply never heard of it. Since then it has reached into almost every aspect of our lives—how we treat the mentally ill, how we understand our relationships, our appreciation of art and artists, and even how we manage our schools, prisons, and workplaces.
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By: Meredith Sneddon,
on 9/12/2014
Rated by the British Medical Journal as one of the top 15 breakthroughs in medicine over the last 150 years evidence-based medicine (EBM) is an idea that has become highly influential in both clinical practice and health policy-making. EBM promotes a seemingly irrefutable principle: that decision-making in medical practice should be based, as much as possible, on the most up-to-date research findings. Nowhere has this idea been more welcome than in psychiatry, a field that continues to be dogged by a legacy of controversial clinical interventions. Many mental health experts believe that following the rules of EBM is the best way of safeguarding patients from unproven fads or dangerous interventions. If something is effective or ineffective, EBM will tell us.
But it turns out that ensuring medical practice is based on solid evidence is not as straightforward as it sounds. After all, evidence does not emerge from thin air. There are finite resources for research, which means that there is always someone deciding what topics should be researched, whose studies merit funding, and which results will be published. These kinds of decisions are not neutral. They reflect the beliefs and values of policymakers, funders, researchers, and journal editors about what is important. And determining what is important depends on one’s goals: improving clinical practice to be sure, but also reaping profits, promoting one’s preferred hypotheses, and advancing one’s career. In other words, what counts as evidence is partly determined by values and interests.
Let’s take a concrete example from psychiatry. The two most common types of psychiatric interventions are medications and psychotherapy. As in all areas of medicine, manufacturers of psychiatric drugs play a very significant role in the funding of clinical research, more significant in dollar amount than government funding bodies. Pharmaceutical companies develop drugs in order to sell them and make profits and they want to do so in such a manner that maximizes revenue. Research into drug treatments has a natural sponsor — the companies who stand to profit from their sales. Meanwhile, psychotherapy has no such natural sponsor. There are researchers who are interested in psychotherapy and do obtain funding in order to study it. However, the body of research data supporting the use of pharmaceuticals is simply much larger and continues to grow faster than the body of data concerning psychotherapy. If one were to prioritize treatments that were evidence-based, one would have no choice but to privilege medications. In this way the values of the marketplace become incorporated into research, into evidence, and eventually into clinical practice.
The idea that values effect what counts as evidence is a particularly challenging problem for psychiatry because it has always suffered from the criticism that it is not sufficiently scientific. A broken leg is a fact, but whether someone is normal or abnormal is seen as a value judgement. There is a hope amongst proponents of evidence-based psychiatry that EBM can take this subjective component out of psychiatry but it cannot. Showing that a drug, like an antidepressant, can make a person feel less sad does not take away the judgement that there is something wrong with being sad in the first place. The thorniest ethical problems in psychiatry surround clinical cases in which psychiatrists and/or families want to impose treatment on mentally ill persons in hopes of achieving a certain mental state that the patient himself does not want. At the heart of this dispute is whose version of a good life ought to prevail. Evidence doesn’t resolve this debate. Even worse, it might end up hiding it. After all, evidence that a treatment works for certain symptoms — like hallucinations — focuses our attention on getting rid of those symptoms rather than helping people in other ways such as finding ways to learn to live with them.
The original authors of EBM worried that clinicians’ values and their exercise of judgment in clinical decision-making actually led to bad decisions and harmed patients. They wanted to get rid of judgment and values as much as possible and let scientific data guide practice instead. But this is not possible. No research is done without values, no data becomes evidence without judgments. The challenge for psychiatry is to be as open as possible about how values are intertwined with evidence. Frank discussion of the many ethical, cultural, and economic factors that inform psychiatry enriches rather than diminishes the field.
Heading image: Lexapro pills by Tom Varco. CC-BY-SA-3.0 via Wikimedia Commons.
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By: Elizabeth Gorney,
on 8/9/2014
Social media and other technologies have changed how we communicate. Consider how we coordinate events and contact our friends and family members today, versus how we did it 20 or 30 years ago. Today, we often text, email, or communicate through social media more frequently than we phone or get together in person.
Now contrast that with psychotherapy, which is still about two people getting together in a room and talking. Certainly, technology has changed psychotherapy. There are now apps for mental health issues. There are virtual reality treatments. Psychotherapy can now be provided through videoconferencing (a.k.a. telehealth). But still, it’s usually simply two people talking in a room.
Our psychotherapy clients communicate with everyone else they know through multiple technological platforms. Should we let them “friend” us on social media? Should we link to them on professional networking sites? Is it ok to text with them? What about email? When are these ok and not ok?
Social Media Explained (with Donuts). Uploaded by Chris Lott. CC-BY-2.0 via Flickr.
Some consensus is emerging about these issues. Experts agree that psychotherapists should not connect with current or former clients on social media. This is to help preserve the clients’ confidentiality. Emailing and texting are fine for communicating brief messages about the parameters of the session, such as confirming the appointment time, or informing the psychotherapist that the client is running late. Research has shown that emotional tone is frequently miscommunicated in texting and email, so emotion-laden topics are best discussed during the session.
How do we learn about new people we’ve met? In the past, we’d talk directly to them, and maybe also talk to people we knew in common. Now everyone seems to search online for everyone else. This happens frequently with first dates, college applicants, and job applicants.
Again, contrast this with psychotherapy. Again, two people are sitting in a room, talking and learning about each other. When is it ok for a psychotherapist to search for information about a client online? What if the psychotherapist discovers important information that the client withheld? How do these discoveries impact the psychotherapy?
No clear consensus has emerged on these issues. Some experts assert that psychotherapists should almost never search online for clients. Other experts respond that it is unreasonable to expect that psychotherapists should not access publicly available information. Others suggest examining each situation on a case-by-case basis. One thing is clear: psychotherapists should communicate with their clients about their policies on internet searches. This should be done in the beginning of psychotherapy, as part of the informed consent process.
When we’ve voluntarily posted information online–and when information about us is readily available in news stories, court documents, or other public sources–we don’t expect this information to be private. For this reason, I find the assertion that psychotherapists can access publically available information to be more compelling. On my intake forms, I invite clients to send me a link to their LinkedIn profile instead of describing their work history, if they prefer. If a client mentions posting her artwork online, I’ll suggest that she send me a link to it or ask her how to find it. I find that clients are pleased that I take an interest.
What about the psychotherapist’s privacy? What if the client follows the psychotherapist’s Twitter account or blog? What if the client searches online for the psychotherapist? What if the client discovers personal information about the psychotherapist by searching? Here’s the short answer: psychotherapists need to avoid posting anything online that we don’t want everyone, including our clients, to see.
Ways to communicate online continue to proliferate. For example, an app that sends only the word “Yo” was recently capitalized to the tune of $2.5 million and was downloaded over 2 million times. Our professional ethics codes are revised infrequently (think years), while new apps and social media are emerging monthly, even daily. Expert consensus on how to manage these new communications technologies emerges slowly (again, think years). But psychotherapists have to respond to new communications technologies in the moment, every day. All we can do is keep the client’s well-being and confidentiality as our highest aspiration.
Jan Willer is a clinical psychologist in private practice. For many years, she trained psychology interns at the VA. She is the author of The Beginning Psychotherapist’s Companion, which offers practical suggestions and multicultural clinical examples to illustrate the foundations of ethical psychotherapy practice. She is interested in continuing to bridge the notorious research-practice gap in clinical psychology. Her seminars have been featured at Northwestern University, the University of Chicago, and DePaul University.
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By: Maxine.,
on 2/28/2013
I’ll start off with two people I’ve met who’ve been both a writer and a therapist. About 25 years ago I knew a therapist who worked with people for a couple of years, then suddenly stopped for no obvious reason. A few months later her book of short stories was published. The linking theme of the collection was the relationship between a psychotherapist and her clients. I knew one of her clients, who was pretty sure one of the stories was about her.
And there’s that tricky job for novelists, finding an authentic, consistent voice for our characters and ourselves. In Closer, Mel speaks of her experience, what she knows, what she guesses, and what she’d rather not know. Readers usually work it out long before Mel does, and have to go along with her as she discovers the truth, her reactions and feelings, and eventually finds a way through. Perhaps I’m inviting people who read my books to listen as accurately as I try to as a psychotherapist, to look beyond the words on the page.
By: Nicola,
on 12/3/2012
What does the baby have to learn in these first 12-18 months (before they can speak)? The list includes what you do with your eyes when with another, how long to hold a mutual gaze, what turn-off head movements work, and with whom, how close you should let the other come to you… how to read body positions… how to enter into turn taking when vocalizing with another… how to joke around, negotiate escalate, back off… make friends, and so on.
Daniel Stern, Forms of Vitality (OUP, 2010) p. 110-111
As a music therapy scholar, teacher, and practitioner for more than 20 years, I have been able to learn from many sources about the crucial role our early years play in our lives. The ability to reflect on challenges experienced in our adult lives by linking back to childhood experiences is an essential aspect of the way that many music therapists practice. Rather than using descriptions of family histories to apportion blame, the therapist tries to understand the current experience of the patient and their worldview through the lens of past experience, to see if there is some way to make sense of self-destructive behaviours, or difficulties experienced in creating meaningful and satisfying relationships with others.
I began my early music therapy practice in mental health services and in nursing homes, working with people diagnosed with Alzheimer’s Disease or other types of dementia. Many people, whether in group or individual music therapy programmes, offered reflections on their early life, and described aspects of their parents’ availability or unavailability; referring to the quality of these first relationships in ways that helped me to understand something of what might have been unresolved or unsatisfying for them. Eventually I found myself very keen to work with people much earlier in life to see whether music therapy could ameliorate some of the issues my older patients were facing.
Although I worked in paediatric music therapy for seven years at a children’s hospital, it was only when I was writing the first proposal to found the (now) international parent-infant support programme Sing & Grow that I had the chance to bring all of my past experience to bear: to make a case for the importance of promoting loving, playful, and nurturing interactions between parents and infants where vulnerability was in evidence. Through my work in this field, I have become increasingly aware of an unrecognised field of practice in music therapy: parent-infant work. This involves the referral of vulnerable parents to a music therapy service. Parents usually attend with their infants and the music therapist provides a safe and accepting space in which the parent and infant pair or group can be encouraged to play and interact in supportive and mutually satisfying ways. This is not always ‘music’ as it might be generally understood; rather it is a musical way of interacting that the therapist encourages.
When adults speak to infants we use particular ways of interaction that seem to be the same across the world. But we should ask why do we use such an exaggerated, playful, and musical way of speaking to infants? The obvious answer is because the infants like it — they raise their eyebrows, fix their gaze on the speaker’s face, and sometimes smile quite quickly on hearing us say ‘ooohhh whooo is my little baaaby?’ This is especially true if the speaker is a family member but it also can occur in new encounters when the conversational partner knows and can offer this communication in a playful and experimental way. However, there are many more powerful scientific and theoretical findings that indicate how this type of interaction builds the bonds of trust and love between parents and infants.
Work by psychobiologist Colwyn Trevarthen, the ethologist Ellen Dissanayake, and researcher Sandra Trehub and her team at the University of Toronto, has paved the way in showing how the functions of this interaction have less to do with entertaining and engaging the baby and are more aligned with the infant’s ability to evoke and interpret these signals from adults and their siblings within weeks of birth. For me, and for the researchers mentioned above, these interactions are easily identified as musical. Observations of the nature of these interactions between parents and infants led Stephen Malloch to coin the term ‘Communicative Musicality’, to capture the unique pitch and rhythmic structures that communicative partners use.
This type of interaction is, as the quote from Stern at the opening attests, playful, rich, and highly involved. It teaches the many skills we need in being able to be with people successfully in intimate relationships, in relationships involving teachers and students, and in work groups. When we do not have adequately rich and supported experiences of attachment in infancy there can be lifelong consequences. Therefore, offering support to parents and infants in difficulty can provide long term benefits. Music therapy is uniquely poised to make a useful contribution to this work as infants are receptive to musical and music-like interactions from sensitive and responsive adults.
Professor Jane Edwards is an Associate Professor at the University of Limerick where she directs the Music & Health Research Group and is co-ordinator of the MA in Music Therapy in the Irish World Academy of Music & Dance. She was formerly a guest professor at the University of the Arts in Berlin (2004-2011). She is President of the International Association for Music & Medicine. She has published extensively in the field of music therapy including Music Therapy and Parent-Infant Bonding (OUP, 2011), and is sole editor for the first Oxford Handbook of Music Therapy (forthcoming).
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View more about this book on the 
Image credit: ‘Mother Kissing Baby’ By Vera Kratochvil (public domain via Wikimedia Commons).
By: admin,
on 5/28/2012
Hickem, Catherine. (2012). Heaven in Her Arms: Why God Chose Mary to Raise His Son and What It Means for You. Nashville, TN: Thomas Nelson. ISBN 978-1-4002-0036-8.
What do we know of Mary?
What we know of Mary’s family is that she is of the house of David; it is from her lineage Jesus fulfilled the prophecy. Given the archeological ruins of the various places thought to have been living quarters for their family, it is likely the home was a room out from which sleeping quarters (cells) branched. As Mary and her mother Anne would be busy maintaining the household, with young Mary working at her mother’s command, it is likely Anne would be nearby or in the same room during the Annunciation. Thus Mary would not have had a scandalous secret to later share with her parents but, rather, a miraculous supernatural experience, the salvific meaning of which her Holy parents would understand and possibly even witnessed.
Mary and Joseph were betrothed, not engaged. They were already married, likely in the form of a marriage contract, but the marriage had not yet been “consummated”. This is why he was going to divorce her when he learned of the pregnancy. If it were a mere engagement, he would have broken it off without too much scandal.
Married but not yet joined with her husband, her mother would prepare her by teaching her all that she needed to know. This is further reason to assume that Mary would be working diligently under her mother’s eye when the Annunciation took place.
We know that her cousin Elizabeth’s pregnancy was kept in secret for five months, and not made known until the sixth month when the Angel Gabriel proclaimed it to Mary. We know Mary then rushed to be at her elderly cousin’s side for three months (the remaining duration of Elizabeth’s pregnancy), and that this rushing appeared to be in response to Elizabeth’s pregnancy (to congratulate her), not an attempt to hide Mary’s pregnancy. Note how all of this is connected to Elizabeth’s pregnancy rather than Mary’s circumstances. As Mary was married to Joseph, he likely would have been informed of the trip. Had the intent been to hide Mary, she would have remained with Elizabeth until Jesus was born, not returned to her family after the first trimester, which is just about the time that her pregnancy was visible and obvious.
So we these misconceptions clarified, we can put Mary’s example within an even deeper context and more fully relate to her experience. We can imagine living in a faith-filled family who raises their child in strict accordance of God’s word. The extended family members may not understand, and certainly their community will not, so Mary, Anne and Joachim, and Joseph face extreme scandal as well as possible action from Jewish authorities. But they faced this together steep in conversation with God, providing a model for today’s family.
Although sometimes scriptural interpretations are flavored with modern-day eye, overall this book will be more than just a quick read for a young mother (or new bride, or teen aspiring to overcome the challenges of American culture, or single parent losing her mind). It is a heartwarming reflection with many examples that open up conversation with God. As an experienced psychotherapist, the author’s examples are spot on and easy to relate to. We do not need to have had the same experiences to empathize, reflect, and pursue meaning; we see it around us in everyday life. As such, a reflective look upon these examples can help one overcome an impasse in their own relationship with God and also open the reader up to self-knowledge as Hi
By: Jennie,
on 12/18/2007
I am going insane. Rapidly. You know how people go slowly insane? Nope I'm hurtling towards insanity in the form of undone cataloging assignments and a term paper.
I really wanted to be done by today. Nope. When I take my final tonight, I'll go home (it will be late) and... I'll do more homework. I cannot wait until this class is all done, except, I can. I mean, I have to have everything in on Thursday, and now I'm really really really freaking out that there isn't enough time...
But, Friday I go home and my sister comes back with us.
So I should probably clean the bathroom first, right?
Anyway, I read another book. (I can't do homework and eat, I can read and eat though.)
Yes, voice is so important. I have been happy with my voice when writing for children. Recently began a book for grown ups but wasn't happy, I couldn't find the voice for this leap into another kind of fiction.
Just came back at end of day's work and re-read this post. Maxine.
I've always wondered how it worked for people who are so involved with others,too so thank you for your thoughtful descriptions.
What an eloquent response to my question, Maxine!
I have similar struggles separating the true life stories I encounter in my teaching job with the stories I am creating as an author. This is when a fantasy setting can be useful.
It is a terrible temptation sometimes to suck up people's life stories like a vampire. I often has to ask myself - is this my story to tell?
Of course it's the same with our neighbours, families and friends! Yes, there are such wonderful stories everywhere...wasn't it DHLawrence who took his characters from his local village, and ended up disliked by all of them!?