The Tyranny of Time: How Long Does Effective Therapy Really Take?

Jonathan Shedler & Enrico Gnaulati
Psychotherapy Networker
Originally posted March/April 20

Here is an excerpt:

Like the Consumer Reports study, this study also found a dose–response relation between therapy sessions and improvement. In this case, the longer therapy continued, the more clients achieved clinically significant change. So just how much therapy did it take? It took 21 sessions, or about six months of weekly therapy, for 50 percent of clients to see clinically significant change. It took more than 40 sessions, almost a year of weekly therapy, for 75 percent to see clinically significant change.

Information from the surveys of clients and therapists turned out to be pretty spot on. Three independent data sources converge on similar time frames. Every client is different, and no one can predict how much therapy is enough for a specific person, but on average, clinically meaningful change begins around the six-month mark and grows from there. And while some people will get what they need with less therapy, others will need a good deal more.

This is consistent with what clinical theorists have been telling us for the better part of a century. It should come as no surprise. Nothing of deep and lasting value is cheap or easy, and changing oneself and the course of one’s life may be most valuable of all.

Consider what it takes to master any new and complex skill, say learning a language, playing a musical instrument, learning to ski, or becoming adept at carpentry. With six months of practice, you might attain beginner- or novice-level proficiency, maybe. If someone promised to make you an expert in six months, you’d suspect they were selling snake oil. Meaningful personal development takes time and effort. Why would psychotherapy be any different?

The info is here.

Four pieces of ethical advice for practitioners during COVID-19

Rebecca Schwartz-Mette
APAservices.org
Originally posted 2 April 20

Are you transitioning to full-time telepsychology? Launching a virtual classroom? Want to expand your competence in the use of technology in practice? You can look to APA’s Ethics Committee for support in transforming your practice. Even in times of crisis, the Ethical Principles of Psychologists and Code of Conduct (hereafter “Ethics Code” or “Code;” 2002, Amended June 1, 2010 and Jan. 1, 2017) continues to guide psychologists’ actions based on our shared values. Here are four ways to practice in good faith while meeting the imminent needs of your community:

Lean in

Across the nation, rather than closing their practices and referring out, psychologists are accepting the challenge to diligently obtain training and expand their competence in telepsychology. Standard 2.02, “Providing Services in Emergencies,” allows psychologists to provide services for individuals for whom other services aren’t available through the duration of such emergencies, even if they have not obtained the necessary training. The Ethics Committee supports those psychologists working in good faith to meet the needs of patients, clients, supervisees and students.

Get training and support

Take advantage of the APA’s new (and often free) resources to develop and expand your competence, in line with Standard 2.03, “Maintaining Competence.” Expand your network by connecting with colleagues who can provide peer consultation and supervision to support your efforts.

Consider referrals

The decision to transition to telepsychology may not be for everyone. Competency concerns, lack of access to technology, and specific needs of particular clients may reflect good reasons to refer to practitioners who can provide telepsychology. Psychologists should assess each client’s needs in light of their own professional capacities and refer to others who can provide needed services in line with Standard 10.10(c), “Terminating Therapy.”

Take care of yourself

Psychologists are human and can feel lost in the ambiguity of this unprecedented time. It is your ethical mandate to also care for yourself. Practicing accurate self-assessment, leaning on colleagues when needed, and taking time to unplug from the news and practice to recharge helps to prevent burnout and is entirely consistent with 2.06, “Personal Problems and Conflicts.” Make self-care a verb and connect with your community of psychologists today.

Suicide attempt survivors’ recommendations for improving mental health treatment for attempt survivors.

Melanie A. Hom and others
Psychological Services. 
Advance online publication.
https://doi.org/10.1037/ser0000415

Abstract

Research indicates that connection to mental health care services and treatment engagement remain challenges among suicide attempt survivors. One way to improve suicide attempt survivors’ experiences with mental health care services is to elicit suggestions directly from attempt survivors regarding how to do so. This study aimed to identify and synthesize suicide attempt survivors’ recommendations for how to enhance mental health treatment experiences for attempt survivors. A sample of 329 suicide attempt survivors (81.5% female, 86.0% White/Caucasian, mean age = 35.07 ± 12.18 years) provided responses to an open-ended self-report survey question probing how treatment might be improved for suicide attempt survivors. Responses were analyzed utilizing both qualitative and quantitative techniques. Analyses identified four broad areas in which mental health treatment experiences might be improved for attempt survivors: (a) provider interactions (e.g., by reducing stigma of suicidality, expressing empathy, and using active listening), (b) intake and treatment planning (e.g., by providing a range of treatment options, including nonmedication treatments, and conducting a thorough assessment), (c) treatment delivery (e.g., by addressing root problems, bolstering coping skills, and using trauma-informed care), and (d) structural issues (e.g., by improving access to care and continuity of care). Findings highlight numerous avenues by which health providers might be able to facilitate more positive mental health treatment experiences for suicide attempt survivors. Research is needed to test whether implementing the recommendations offered by attempt survivors in this study might lead to enhanced treatment engagement, retention, and outcomes among suicide attempt survivors at large.

Here is an excerpt from the Discussion:

On this point, this study revealed numerous recommendations for how providers might be able to improve their interactions with attempt survivors. Suggestions in this domain aligned with prior studies on treatment experiences among suicide attempt survivors. For instance, recommendations that providers not stigmatize attempt survivors and, instead, empathize with them, actively listen to them, and humanize them, are consistent with aforementioned studies (Berglund et al., 2016; Frey et al., 2016; Shand et al., 2018; Sheehan et al., 2017; Taylor et al., 2009). This study’s findings regarding the importance of a collaborative therapeutic relationship are also consistent with previous work (Shand et al., 2018). Though each of these factors has been identified as salient to treatment engagement efforts broadly (see Barrett et al., 2008, for review), several suggestions that emerged in this study were more specific to attempt survivors. For example, ensuring that patients feel comfortable openly discussing suicidal thoughts and behaviors and taking disclosures of suicidality seriously are suggestions specifically applicable to the care of at-risk individuals. These recommendations not only support research indicating that asking about suicidality is not iatrogenic (see DeCou & Schumann, 2018, for review), but they also underscore the importance of considering the unique needs of attempt survivors. Indeed, given that most participants provided a recommendation in this area, the impact of provider-related factors should not be overlooked in the provision of care to this group.

Humility and self-doubt are hallmarks of a good therapist

Helene Nissen-Lie
aeon.co
Originally posted 5 Feb 20

Here is an excerpt:

However, therapist humility on its own is not sufficient for therapy to be effective. In our latest study, we assessed how much therapists treat themselves in a kind and forgiving manner in their personal lives (ie, report more ‘self-affiliation’) and their perceptions of themselves professionally. We anticipated that therapists’ level of personal self-affiliation would enhance the effect that professional self-doubt has on therapeutic change. Our hypothesis was supported: therapists who reported more self-doubt in their work alleviated client distress more if they also reported being kind to themselves outside of work (in contrast, therapists who scored low on self-doubt and high on self-affiliation contributed to the least change).

We interpreted this finding to imply that a benign self-critical stance in a therapist is beneficial, but that self-care and forgiveness without reflective self-criticism is not. The combination of self-affiliation and professional self-doubt seems to pave the way for an open, self-reflective attitude that allows psychotherapists to respect the complexity of their work, and, when needed, to correct the therapeutic course to help clients more effectively.

What does all this mean? At a time when people tend to think that their value is based on how confident they are and that they must ‘sell themselves’ in every situation, the finding that therapist humility is an underrated virtue and a paradoxical ingredient of expertise might be a relief.

The info is here.

Burnout as an ethical issue in psychotherapy.

Simionato, G., Simpson, S., & Reid, C.
Psychotherapy, 56(4), 470–482.

Abstract

Recent studies highlight a range of factors that place psychotherapists at risk of burnout. The aim of this study was to investigate the ethics issues linked to burnout among psychotherapists and to describe potentially effective ways of reducing vulnerability and preventing collateral damage. A purposive critical review of the literature was conducted to inform a narrative analysis. Differing burnout presentations elicit a wide range of ethics issues. High rates of burnout in the sector suggest systemic factors and the need for an ethics review of standard workplace practice. Burnout costs employers and taxpayers billions of dollars annually in heightened presenteeism and absenteeism. At a personal level, burnout has been linked to poorer physical and mental health outcomes for psychotherapists. Burnout has also been shown to interfere with clinical effectiveness and even contribute to misconduct. Hence, the ethical impact of burnout extends to our duty of care to clients and responsibilities to employers. A range of occupational and personal variables have been identified as vulnerability factors. A new 5-P model of prevention is proposed, which combines systemic and individually tailored responses as a means of offering the greatest potential for effective prevention, identification, and remediation. In addition to the significant economic impact and the impact on personal well-being, burnout in psychotherapists has the potential to directly and indirectly affect client care and standards of professional practice. Attending to the ethical risks associated with burnout is a priority for the profession, for service managers, and for each individual psychotherapist.

From the Conclusion:

Burnout is a common feature of unintentional misconduct among psychotherapists, often at the expense of client well-being, therapeutic progress, and successful client outcomes. Clinicians working in spite of burnout also incur personal and economic costs that compromise the principles of competence and beneficence outlined in ethical guidelines. This article has focused on a communitarian approach to identifying, understanding, and responding to the signs, symptoms, and risk factors in an attempt to harness ethical practice and foster successful careers in psychotherapy. The 5-P strength-based model illuminates the positive potential of workplaces that support wellbeing and prioritize ethical practice through providing an individualized responsiveness to the training, professional development, and support needs of staff. Further, in contrast to the majority of the literature that explores organizational factors leading to burnout and ethical missteps, the 5-P model also considers the personal characteristics that may contribute to burnout and the personal action that
psychotherapists can take to avoid burnout and unintentional misconduct.

The info is here.

American Psychological Association Calls for Immediate Halt to Sharing Immigrant Youths' Confidential Psychotherapy Notes with ICE

American Psychological Association
Press Release
Released 17 Feb 20

The American Psychological Association expressed shock and outrage that the federal Office of Refugee Resettlement has been sharing confidential psychotherapy notes with U.S. Immigration and Customs Enforcement to deny asylum to some immigrant youths.

“ORR’s sharing of confidential therapy notes of traumatized children destroys the bond of trust between patient and therapist that is vital to helping the patient,” said APA President Sandra L. Shullman, PhD. “We call on ORR to stop this practice immediately and on the Department of Health and Human Services and Congress to investigate its prevalence. We also call on ICE to release any immigrants who have had their asylum requests denied as a result.”

APA was reacting to a report in The Washington Post focused largely on the case of then-17-year-old Kevin Euceda, an asylum-seeker from Honduras whose request for asylum was granted by a judge, only to have it overturned when lawyers from ICE revealed information he had given in confidence to a therapist at a U.S. government shelter. According to the article, other unaccompanied minors have been similarly detained as a result of ICE’s use of confidential psychotherapy notes. These situations have also been confirmed by congressional testimony since 2018.

Unaccompanied minors who are detained in U.S. shelters are required to undergo therapy, ostensibly to help them deal with trauma and other issues arising from leaving their home countries. According to the Post, ORR entered into a formal memorandum of agreement with ICE in April 2018 to share details about children in its care. The then-head of ORR testified before Congress that the agency would be asking its therapists to “develop additional information” about children during “weekly counseling sessions where they may self-disclose previous gang or criminal activity to their assigned clinician,” the newspaper reported. The agency added two requirements to its public handbook: that arriving children be informed that while it was essential to be honest with staff, self-disclosures could affect their release and that if a minor mentioned anything having to do with gangs or drug dealing, therapists would file a report within four hours to be passed to ICE within one day, the Post said.

"For this administration to weaponize these therapy sessions by ordering that the psychotherapy notes be passed to ICE is appalling,” Shullman added. “These children have already experienced some unimaginable traumas. Plus, these are scared minors who may not understand that speaking truthfully to therapists about gangs and drugs – possibly the reasons they left home – would be used against them.”

The Ethical Practice of Psychotherapy: Clearly Within Our Reach

Jeff Barnett
Psychotherapy, 56(4), 431-440
http://dx.doi.org/10.1037/pst0000272

Abstract

This introductory article to the special section on ethics in psychotherapy highlights the challenges and ethical dilemmas psychotherapists regularly face throughout their careers, and the limits of the American Psychological Association Ethics Code in offering clear guidance for how specifically to respond to each of these situations. Reasons for the Ethics Code’s naturally occurring limitations are shared. The role of ethical decision-making, the use of multiple sources of guidance, and the role of consultation with colleagues to augment and support the psychotherapist’s professional judgment are illustrated. Representative ethics challenges in a range of areas of practice are described, with particular attention given to tele-mental health and social media, interprofessional practice and collaboration with medical professionals, and self-care and the promotion of wellness. Key recommendations are shared to promote ethical conduct and to resolve commonly occurring ethical dilemmas in each of these areas of psychotherapy practice. Each of the six articles that follow in this special section on ethics in psychotherapy are introduced, and their main points are summarized.

Here is an excerpt:

Yet, the ethical practice of psychotherapy is complex and multifaceted. This is true as well for psychotherapy research, the supervision of psychotherapy by trainees, and all other professional roles in which psychotherapists may serve. Psychotherapists engage in complex and challenging work in a wide range of practice settings, with a diverse range of clients/patients with highly individualized treatment needs, histories, and circumstances, using a plethora of possible treatment techniques and strategies. Each possible combination of these factors can yield a range of complexities, often presenting psychotherapists with challenges and situations that may not have been anticipated and that tax the psychotherapist’s ability to choose the correct or most appropriate course of action. In such circumstances, ethical dilemmas (situations in which no right or correct course of action is readily apparent and where multiple factors may influence or impact one’s decision on how to proceed) are common. Knowing how to respond to these challenges and dilemmas is of paramount importance for psychotherapists so that we may fulfill our overarching obligations to our clients and all others we serve in our professional roles.

Veterans Must Also Heal From Moral Injury After War

Camillo Mac Bica
truthout.org
Originally published Nov 11, 2019

Here are two excerpts:

Humankind has identified and internalized a set of values and norms through which we define ourselves as persons, structure our world and render our relationship to it — and to other human beings — comprehensible. These values and norms provide the parameters of our being: our moral identity. Consequently, we now have the need and the means to weigh concrete situations to determine acceptable (right) and unacceptable (wrong) behavior.

Whether an individual chooses to act rightly or wrongly, according to or in violation of her moral identity, will affect whether she perceives herself as true to her personal convictions and to others in the moral community who share her values and ideals. As the moral gravity of one’s actions and experiences on the battlefield becomes apparent, a warrior may suffer profound moral confusion and distress at having transgressed her moral foundations, her moral identity.

Guilt is, simply speaking, the awareness of having transgressed one’s moral convictions and the anxiety precipitated by a perceived breakdown of one’s ethical cohesion — one’s integrity — and an alienation from the moral community. Shame is the loss of self-esteem consequent to a failure to live up to personal and communal expectations.

(cut)

Having completed the necessary philosophical and psychological groundwork, veterans can now begin the very difficult task of confronting the experience. That is, of remembering, reassessing and morally reevaluating their responsibility and culpability for their perceived transgressions on the battlefield.

Reassessing their behavior in combat within the parameters of their increased philosophical and psychological awareness, veterans realize that the programming to which they were subjected and the experience of war as a survival situation are causally connected to those specific battlefield incidents and behaviors, theirs and/or others’, that weigh heavily on their consciences — their moral injury. As a consequence, they understand these influences as extenuating circumstances.

Finally, as they morally reevaluate their actions in war, they see these incidents and behaviors in combat not as justifiable, but as understandable, perhaps even excusable, and their culpability mitigated by the fact that those who determined policy, sent them to war, issued the orders, and allowed the war to occur and/or to continue unchallenged must share responsibility for the crimes and horror that inevitably characterize war.

The info is here.

Suicide Has Been Deadlier Than Combat for the Military

Carol Giacomo
The New York Times
Originally published November 1, 2019

Here are two excerpts:

The data for veterans is also alarming.

In 2016, veterans were one and a half times more likely to kill themselves than people who hadn’t served in the military, according to the House Committee on Oversight and Reform.

Among those ages 18 to 34, the rate went up nearly 80 percent from 2005 to 2016.

The risk nearly doubles in the first year after a veteran leaves active duty, experts say.

The Pentagon this year also reported on military families, estimating that in 2017 there were 186 suicide deaths among military spouses and dependents.

(cut)

Experts say suicides are complex, resulting from many factors, notably impulsive decisions with little warning. Pentagon officials say a majority of service members who die by suicide do not have mental illness. While combat is undoubtedly high stress, there are conflicting views on whether deployments increase risk.

Where there seems to be consensus is that high-quality health care and keeping weapons out of the hands of people in distress can make a positive difference.

Studies show that the Department of Veterans Affairs provides high-quality care, and its Veterans Crisis Line “surpasses most crisis lines” operating today, according to Terri Tanielian, a researcher with the RAND Corporation. (The Veterans Crisis Line is staffed 24/7 at 800-273-8255, press 1. Services also are available online or by texting 838255.)

But Veterans Affairs often can’t accommodate all those needing help, resulting in patients being sent to community-based mental health professionals who lack the training to deal with service members.

The info is here.

Treatments for the Prevention and Management of Suicide: A Systematic Review.

D'Anci KE, Uhl S, Giradi G, et al.
Ann Intern Med. 
doi: 10.7326/M19-0869

Abstract

Background:
Suicide is a growing public health problem, with the national rate in the United States increasing by 30% from 2000 to 2016.

Purpose:
To assess the benefits and harms of nonpharmacologic and pharmacologic interventions to prevent suicide and reduce suicide behaviors in at-risk adults.

Conclusion:
Both CBT and DBT showed modest benefit in reducing suicidal ideation compared with TAU or wait-list control, and CBT also reduced suicide attempts compared with TAU. Ketamine and lithium reduced the rate of suicide compared with placebo, but there was limited information on harms. Limited data are available to support the efficacy of other nonpharmacologic or pharmacologic interventions.

Discussion

In this SR, we reviewed and synthesized evidence from 8 SRs and 15 RCTs of nonpharmacologic and pharmacologic interventions intended to prevent suicide in at-risk persons. These interventions are a subset of topics included in the updated VA/DoD 2019 CPG for assessment and management of patients at risk for suicide. The full final guideline is available from the VA Web site (www.healthquality.va.gov).

Nonpharmacologic interventions encompassed a range of approaches delivered either face-to-face or via the Internet or other technology. We found moderate-strength evidence supporting the use of face-to-face or Internet-delivered CBT in reducing suicide attempts, suicidal ideation, and hopelessness compared with TAU. We found low-strength evidence suggesting that CBT was not effective in reducing suicides. However, rates of suicide were generally low in the included studies, which limits our ability to draw firm conclusions about this outcome. Data from small studies provide low-strength evidence supporting the use of DBT over client-oriented therapy or control for reducing suicidal ideation. For other outcomes and other comparisons, we found no benefit of DBT. There was low-strength evidence supporting use of WHO-BIC to reduce suicide, CRP to reduce suicide attempts, and Window to Hope to reduce suicidal ideation and hopelessness.

Nudging Humans

Brett M. Frischmann
Villanova University - School of Law
Originally published August 1, 2019

Abstract

Behavioral data can and should inform the design of private and public choice architectures. Choice architects should steer people toward outcomes that make them better off (according to their own interests, not the choice architects’) but leave it to the people being nudged to choose for themselves. Libertarian paternalism can and should provide ethical constraints on choice architects. These are the foundational principles of nudging, the ascendant social engineering agenda pioneered by Nobel Prize winning economist Richard Thaler and Harvard law professor Cass Sunstein.

The foundation bears tremendous weight. Nudging permeates private and public institutions worldwide. It creeps into the design of an incredible number of human-computer interfaces and affects billions of choices daily. Yet the foundation has deep cracks.

This critique of nudging exposes those hidden fissures. It aims at the underlying theory and agenda, rather than one nudge or another, because that is where micro meets macro, where dynamic longitudinal impacts on individuals and society need to be considered. Nudging theorists and practitioners need to better account for the longitudinal effects of nudging on the humans being nudged, including malleable beliefs and preferences as well as various capabilities essential to human flourishing. The article develops two novel and powerful criticisms of nudging, one focused on nudge creep and another based on normative myopia. It explores these fundamental flaws in the nudge agenda theoretically and through various examples and case studies, including electronic contracting, activity tracking in schools, and geolocation tracking controls on an iPhone.

The paper is here.

Assessment of Patient Nondisclosures to Clinicians of Experiencing Imminent Threats

Levy AG, Scherer AM, Zikmund-Fisher BJ, Larkin K, Barnes GD, Fagerlin A.
JAMA Netw Open. Published online August 14, 20192(8):e199277.
doi:10.1001/jamanetworkopen.2019.9277

Question 

How common is it for patients to withhold information from clinicians about imminent threats that they face (depression, suicidality, abuse, or sexual assault), and what are common reasons for nondisclosure?

Findings 

This survey study, incorporating 2 national, nonprobability, online surveys of a total of 4,510 US adults, found that at least one-quarter of participants who experienced each imminent threat reported withholding this information from their clinician. The most commonly endorsed reasons for nondisclosure included potential embarrassment, being judged, or difficult follow-up behavior.

Meaning

These findings suggest that concerns about potential negative repercussions may lead many patients who experience imminent threats to avoid disclosing this information to their clinician.

Conclusion

This study reveals an important concern about clinician-patient communication: if patients commonly withhold information from clinicians about significant threats that they face, then clinicians are unable to identify and attempt to mitigate these threats. Thus, these results highlight the continued need to develop effective interventions that improve the trust and communication between patients and their clinicians, particularly for sensitive, potentially life-threatening topics.

Study: College Presidents Prioritizing Student Mental Health

Jeremy Bauer-Wolf
InsideHigherEd.com
Originally posted August 12, 2019

With college students reporting problems with anxiety and depression more than ever before, and suicides now a big problem on campuses, university presidents are responding accordingly.

More than 80 percent of top university executives say that mental health is more of a priority on campus than it was three years ago, according to a new report released today by the American Council on Education.

"Student mental health concerns have escalated over the last 10 years," the report states. "We wanted to know how presidents were responding to this increase. To assess short-term changes, we asked presidents to reflect on the last three years on their campus and whether they have observed an increase, decrease, or no change in how they prioritize mental health."

ACE, which represents more than 1,700 college and university presidents, surveyed more than 400 college and university leaders from two- and four-year public and private institutions. About 78 percent of those surveyed were at four-year universities, and the remainder led two-year institutions.

The association found 29 percent of all the presidents surveyed received reports of students with mental health issues once a week or more. About 42 percent of the presidents reported hearing about these problems at least a few times every month. As a result, presidents have allocated more funding to addressing student mental health problems -- 72 percent of the presidents indicated they had spent more money on mental health initiatives than they did three years ago. One unnamed president even reported spending $15 million on a new “comprehensive student well-being building.”

The info is here.

Psychologist Found Guilty of Sexual Assault During Psychotherapy

Richard Bammer
www.mercurynews.com
Originally published July 27, 2019

A Solano County Superior Court judge on Friday sentenced to more than 11 years behind bars a former Travis Air Force Base psychologist found guilty last fall of a series of felony sexual assaults on female patients and three misdemeanor counts.

After hearing victim impact testimony and statements from attorneys — but before pronouncing the prison term — Judge E. Bradley Nelson looked directly at Heath Jacob Sommer, 43, saying he took a version of exposure therapy “to a new level” and used his “position of trust” between 2014 and 2016 to repeatedly take advantage of “very vulnerable people,” female patients who sought his help to cope with previous sexual trauma while on active duty.

And following a statement from Sommer — “I apologize … I never intended to be offensive to people,” he said — Nelson enumerated the counts, noting the second one, rape, would account for the greatest number of years, eight, in state prison, with two other felonies, oral copulation by fraudulent representation and sexual battery by fraudulent means, filling out the balance.

Nelson added 18 months in Solano County Jail for three misdemeanor charges of sexual battery for the purpose of sexual arousal. He then credited Sommer, shackled at the waist in a striped jail jumpsuit and displaying no visible reaction to the sentence, with 904 days in custody. Additionally, Sommer will be required to serve 20 years probation upon release, register as a sex offender for life, and pay nearly $10,000 in restitution to the victims and other court costs.

The info is here.

DC Types Have Been Flocking to Shrinks Ever Since Trump Won.

And a Lot of the Therapists Are Miserable.

Britt Peterson
www.washingtonian.com
Originally published July 14 2019

Here two excerpts:

In Washington, the malaise appears especially pronounced. I spent the last several months talking to nearly two dozen local therapists who described skyrocketing levels of interest in their services. They told me about cases of ordinary stress blossoming into clinical conditions, patients who can’t get through a session without invoking the President’s name, couples and families falling apart over politics—a broad category of concerns that one practitioner, Beth Sperber Richie, says she and her colleagues have come to categorize as “Trump trauma.”

In one sense, that’s been good news for the people who help keep us sane: Their calendars are full. But Trump trauma has also created particular clinical challenges for therapists like Guttman and her students. It’s one thing to listen to a client discuss a horrible personal incident. It’s another when you’re experiencing the same collective trauma.

“I’ve been a therapist for a long time,” says Delishia Pittman, an assistant professor at George Washington University who has been in private practice for 14 years. “And this has been the most taxing two years of my entire career.”

(cut)

For many, in other words, Trump-related anxieties originate from something more serious than mere differences about policy. The therapists I spoke to are equally upset—living through one unnerving news cycle after another, personally experiencing the same issues as their patients in real time while being expected to offer solace and guidance. As Bindeman told her clients the day after Trump’s election, “I’m processing it just as you are, so I’m not sure I can give you the distance that might be useful.”

This is a unique situation in therapy, where you’re normally discussing events in the client’s private life. How do you counsel a sexual-assault victim agitated by the Access Hollywood tape, for example, when the tape has also disturbed you—and when talking about it all day only upsets you further? How about a client who echoes your own fears about climate change or the treatment of minorities or the government shutdown, which had a financial impact on therapists just as it did everyone else?

Again and again, practitioners described different versions of this problem.

The info is here.

Therapist accused of sending client photos of herself in lingerie can’t get her state license back: Pa. court

Matt Miller
www.pennlive.com
Originally posted July 17, 2019

A therapist who was accused of sending a patient photos of herself in lingerie can’t have her state counseling license back, a Commonwealth Court panel ruled Wednesday.

That is so even though Sheri Colston denied sending those photos or having any inappropriate interactions with the male client, the court found in an opinion by Judge Robert Simpson.

The court ruling upholds an indefinite suspension of Colston’s license imposed by the State Board of Social Workers, Marriage and Family Therapists and Professional Counselors. That board also ordered Colston to pay $7,409 to cover the cost of investigating her case.

The info is here.

Campuses Are Short on Mental-Health Counselors. But They’ve Got Plenty of Antidepressants.

Lily Jackson

The Chronicle of Higher Education
Originally posted June 28, 2019

Here is an excerpt:

A Potential for Lopsided Treatment

It is generally accepted that the most effective treatment for medium-to-severe depression is a mix of therapy and medication. But on most college campuses, it’s easier to get the latter than the former.

A student experiencing symptoms of depression who wants to see a counselor may have to wait weeks. The average wait for a first-time appointment among all college counseling centers is about seven business days, according to a report by the Association for University and College Counseling Center Directors. And nearly two-thirds of counseling directors whose centers offer psychiatric services say they need “more hours of psychiatric services than they currently have to meet student needs,” according to the same report.

On many campuses, the path to a prescription is simpler. A student can walk into a campus clinic where a medical employee can administer an evaluation called the PHQ-9, a nine-question rubric, commonly used across medicine, that assesses the patient's well-being with questions like, “Have you been feeling blue for the last two weeks?” and “Have you experienced thoughts of suicide?”

Based on the student’s evaluation score, psychologists can direct them toward medication or therapy, or both, based on the severity of their symptoms. Some students are seeking mental health resources with a driving force of “instant relief,” said Gregory Eells, executive director of Counseling and Psychological Services at the University of Pennsylvania and the president-elect of Aucccd.

So they tell their physician what they want, Eells said, rather than inquiring about what they need.

It’s common, experts say, for a patient to leave the first visit with a prescription for an antidepressant.

“Most students come in knowing one thing: They want help,” said William E. Neighbor, clinical professor of family medicine at the University of Washington Hall Health Center. “They are interested in medications because most have friends who have been on them.”

The info is here.

134 Activities to Add to Your Self-Care Plan

GoodTherapy.org Staff
www.goodtherapy.org
Originally posted June 13, 2015

At its most basic definition, self-care is any intentional action taken to meet an individual’s physical, mental, spiritual, or emotional needs. In short, it’s all the little ways we take care of ourselves to avoid a breakdown in those respective areas of health.

You may find that, at certain points, the world and the people in it place greater demands on your time, energy, and emotions than you might feel able to handle. This is precisely why self-care is so important. It is the routine maintenance you need do to function your best not only for others, but also for yourself.

GoodTherapy.org’s own business and administrative, web development, outreach and advertising, editorial and education, and support teams have compiled a massive list of some of their own personal self-care activities to offer some help for those struggling to come up with their own maintenance plan. Next time you find yourself saying, “I really need to do something for myself,” browse our list and pick something that speaks to you. Be silly, be caring to others, and make your self-care a priority! In most cases, taking care of yourself doesn’t even have to cost anything. And because self-care is as unique as the individual performing it, we’d love to invite you to comment and add any of your own personal self-care activities in the comments section below. Give back to your fellow readers and share some of the little ways you take care of yourself.

The list is here.

Note: Self-care enhances the possibility of competence practice.  Good self-care skills are important to promote ethical practice.

Ordinary people associate addiction with loss of free will

A. J. Vonasch, C. J. Clark, S. Laub, K. D. Vohs, & R. F. Baumeister
Addictive Behaviors Reports
Volume 5, June 2017, Pages 56-66

Introduction
It is widely believed that addiction entails a loss of free will, even though this point is controversial among scholars. There is arguably a downside to this belief, in that addicts who believe they lack the free will to quit an addiction might therefore fail to quit an addiction.

Methods
A correlational study tested the relationship between belief in free will and addiction. Follow-up studies tested steps of a potential mechanism: 1) people think drugs undermine free will 2) people believe addiction undermines free will more when doing so serves the self 3) disbelief in free will leads people to perceive various temptations as more addictive.

Results
People with lower belief in free will were more likely to have a history of addiction to alcohol and other drugs, and also less likely to have successfully quit alcohol. People believe that drugs undermine free will, and they use this belief to self-servingly attribute less free will to their bad actions than to good ones. Low belief in free will also increases perceptions that things are addictive.

Conclusions
Addiction is widely seen as loss of free will. The belief can be used in self-serving ways that may undermine people's efforts to quit.

The research is here.

The Fake Sex Doctor Who Conned the Media Into Publicizing His Bizarre Research on Suicide, Butt-Fisting, and Bestiality

Jennings Brown
www.gizmodo.com
Originally published March 1, 2019

Here is an excerpt:

Despite Sendler’s claims that he is a doctor, and despite the stethoscope in his headshot, he is not a licensed doctor of medicine in the U.S. Two employees of the Harvard Medical School registrar confirmed to me that Sendler was never enrolled and never received a MD from the medical school. A Harvard spokesperson told me Sendler never received a PhD or any degree from Harvard University.

“I got into Harvard Medical School for MD, PhD, and Masters degree combined,” Sendler told me. I asked if he was able to get a PhD in sexual behavior from Harvard Medical School (Harvard Medical School does not provide any sexual health focuses) and he said “Yes. Yes,” without hesitation, then doubled-down: “I assume that there’s still some kind of sense of wonder on campus [about me]. Because I can see it when I go and visit [Harvard], that people are like, ‘Wow you had the balls, because no one else did that,’” presumably referring to his academic path.

Sendler told me one of his mentors when he was at Harvard Medical School was Yi Zhang, a professor of genetics at the school. Sendler said Zhang didn’t believe in him when he was studying at Harvard. But, Sendler said, he met with Zhang in Boston just a month prior to our interview. And Zhang was now impressed by Sendler’s accomplishments.

Sendler said Zhang told him in January, “Congrats. You did what you felt was right... Turns out, wow, you have way more power in research now than I do. And I’m just very proud of you, because I have people that I really put a lot of effort, after you left, into making them the best and they didn’t turn out that well.”

The info is here.

This is a fairly bizarre story and worth the long read.