Past, present and suture
An article in yesterday's New York Times reports that psychotherapy has changed over the past few years to focus on the present, not the past. Talking about childhood traumas, the Times says, is being replaced by cognitive behavior therapy (CBT), which focuses exclusively on the present. Seems to me the Times is coming a little late to the party, as CBT has been around forever. They can be a little behind the curve, my sweet NYT. CBT is mainstream treatment now.
Last week's Time magazine has a different take. Psychologist Stephen Hayes (who's described in this article as a "mental patient"; very P.C.) "advises sufferers not to fight negative feelings but to accept them as part of life. Happiness, the book says, is not normal." Hayes has a new twist on CBT, he says. Time's John Cloud writes: "Whereas cognitive therapists speak of 'cognitive errors' and 'distorted interpretations,' Hayes and the others teach mindfulness, the meditation-inspired practice of observing thoughts without getting entangled in them, approaching them as though they were leaves floating down a stream." Ew.
And this week syndicated advice columnist Dan Savage offered some very CBT-type counsel to a guy who lost his virginity to his mother when he was 15. The guy's psychotherapist suggested he won't be able to have normal relationships until he deals with the sexual abuse and confronts his mother about the incident. Savage has some harsh words for the therapist: "Fuck your therapist, TGS. She's not your parole officer-you don't have to do what she says, and you're free to go find another therapist if she's pissing you off."
More and More, Favored Psychotherapy Lets Bygones Be Bygones [NY Times]
Savage Love [PW]
Happiness Isn't Normal [Time]
[Photo of cigars—because sometimes a cigar is just a cigar—courtesy of Van Wyk Design, who made the pretty bands.]
Comments
Despite "CBT being around forever" it difficult to find a professional who practices it. Too many therapists claim to utilize CBT but it is often endless talk therapy which fails to embody any of the elements of CBT. Then there is the fact that many consumers can't avail themselves of CBT in light of their economic realities.
Medicaid now pays for over half of America's mental health services. Medicare reimburses covered individuals for only half the approved amount when it comes to outpatient mental health services while typically paying 80% for other outpatient care. The only avenue for many consumers is the public mental health system which is stretched by overwhelming demand and inadequate resources. Low salaries make it difficult for community mental health centers to attract professionals who have been trained in CBT.
CBT is a wonderful modality. Sadly, too many find that mental health services are what you can get when it may be difficult to get any services at all.
Posted by: Joe | February 15, 2006 06:19 PM
some good points, and i agree with joe as well. a defeatist internal dialogue can be crippling. cbt, like many worthwhile efforts in medicine such as preventative care, is devalued and poorly reimbursed and much less sexy than a simple round pill. a shame. nice cigars.
Posted by: aidan | February 16, 2006 02:49 AM
I've been reading your column for years now and it has provided me an exteremly valuable assisstance in my recovery from mental illness and my psychotherapy practice at a community mental health center.
Like you my main goal in life is making it day to day while offering hope and empathy for my severely mentallly ill clients. But my time for nuturing others is running out.
After thirty years as a practicing psychotherapist I find that I must, for my own recovery, admit that I can no loner perform my activities as a mental health specialist to the degree that I've subscribed.
In thirty years I've seen it all and managed to find growth for myself and my clients. Now I'm coming to a lost for finding the gifts that I've offered due to the severity of my own illness.
I was permanently disabled for almost ten years and could hardly function in life. After many hospitalizations, med changes and ECT I slowly regained my faculties and humanity and returned to work. I continue to endeavour to provide the best of care for my clients but I'm sometimes fighting a battle for my own grasp on reality that robs me of my sense of purpose in assissting others. When I'm with my clients I am truely there for them but my personal integrety is continually robbed of some of the most elementary abilities that allow a consumer to treat a very needy population.
My therapist, PDoc and friends and family are supportive in my sense that it may be time to end my professional career and move on to something that will be less stressful and more suited to the reality of my severe bi-polar disorder. I come to this conclusion with dissappointment and regret.
I'm a good therapist. And also very ill.
I've had to withdraw from facilitating a support group as it was too much to contribute to the needs of more consumers when I really need a forum to help me with my own needs that were not being met.
I have five rescued critters that give me affection, loyaliity and hope.
I'm not sure where I'm going to wind up in the near future. I've signed up for training from the Office of Vocational Training but am at a loss to see what is in the future for a mentally disabled clinician who has met the end of his game.
I look forward to your columns and blogs as they give me encouragement that I'm not alone in this fight and that the pain of my experience and uncertainity for my future are shared by a wonderful individual.
Please keep writing. There are many of us who need you.
My thanks and very best to you.
Love and Peace,
Joshua.
Posted by: Joshua | February 19, 2006 04:57 PM