Brody et al (2001) studied 24 untreated patients with major depressive disorder (MDD). Positron Emission Tomography (PET) brain imaging was used to provide images of the patients before and after 12 weeks of either interpersonal psychotherapy treatment or pharmacologically with Paroxetin (an SSRI). A control group of non-depressive patients were also evaluated.
Subjects with depressive symptoms at the baseline had higher metabolism than the control group in the prefrontal cortex (PFF), and lower metabolism in the temporal lobe (TL).
With treatment, the depressive subjects showed metabolic changes. Their brain scans changed to match those belonging to the normal group.
The Hamilton Depression Rating scale was used to access the experience of depression in the subjects. In both treatment groups the subjects saw decrease in depression experience. However theparoxetine-treated subjects had a greater mean decrease in Hamilton Depression Rating Scale score (61.4%) than did subjects treated with interpersonal psychotherapy (38.0%).
Both subgroups showed decreases in normalized PFF and left anterior cingulate gyrus metabolism and increases in normalized left temporal lobe metabolism; the paroxetine-treated bilaterally, while interpersonal psychotherapy-treated on the right.
This study showed that inter-personal therapy treatment effected change in the metabolic activity in the brain. The effect of the treatment is also moderately different as that from pharmacological treatment.
Further study by Martin et al. (2001), using Single-Photon-Emission Computer Tomography (SPECT), comparing 28 depressive patients treated with 6 weeks of interpersonal psychotherapy and depressive patients treated with Venlafaxin(a SSNRI).
The researchers discovered, after 6 weeks of treatment, both groups of patients showed increased cerebral blood flow in the right basal ganglia. However, when they tested the patients again on the 12th week (this means 6 weeks after treatment has completed), only the psychotherapeutically treated patients retained the increased blood flow in the right posterior cingulum.
What the studies tell us is that the treatment of depression with inter-personal psychotherapy and pharmaceuticals do alleviate depressive symptoms.
Biologically, however there is a difference in how both types of treatment work.
The significant point of the studies is, that although pharmaceutical treatment seem to work as well as psychotherapy, the effect of interpersonal psychotherapy is lasting. 6 weeks after treatment has ended, the client keeps the benefits of the psychotherapeutic treatment. Pharmaceutical treatment was shown, however, to be transient, setting the patient back to original condition when the drugs are discontinued.
Brody, A. L., Saxena, S., Stoessel, P., Gillies, L. A., Fairbanks, L. A., Alborzian, S., … & Ho, M. K. (2001). Regional brain metabolic changes in patients with major depression treated with either paroxetine or interpersonal therapy: preliminary findings. Archives of general psychiatry, 58(7), 631-640.
Martin, S. D., Martin, E., Rai, S. S., Richardson, M. A., & Royall, R. (2001). Brain blood flow changes in depressed patients treated with interpersonal psychotherapy or venlafaxine hydrochloride: preliminary findings. Archives of General Psychiatry, 58(7), 641-648.
When is it a good time to decide to get psychotherapy? What has to happen before someone actually needs psychotherapy? Does seeing a therapist mean that I am sick / crazy?
Nobody has to ask these questions when one is physically ill. One goes directly to the general practitioner, because it is clear to one that his/her body is not feeling as good as it normally does. Psychological health is slightly different, the degree of suffering is not so clear, and often we feel “it is not necessary” or “I can get through this” and/or “it is to much of a luxury” to get psychotherapy. Oftentimes ignored emotional challenges (which can be unpacked in psychotherapy) lead to debilitating mental suffering in later life.
Certainly this article come from within a psychotherapist’s blog. It is however the intention of the author to shed light on the “hows”, “whys” and “what for” in seeking psychotherapeutic treatment. As a psychotherapist having worked also in psychiatric wards in hospitals, I’m also a witness to how mental health of an individual today is vulnerable to life-changing situations.
Individuals who attend therapy when they can still work and function in their daily lives have better prognosis than those who are at already a point where their psychological state does not allow them to live independently of others or medication.
When is appropriate time to seek psychotherapy?
Imagine these rather normal scenarios:
Scenario 1: Your child is not sleeping well, and has frequent nightmares. In the day he is agitated and has problem paying attention. This is stressful for you, because you are at a loss in managing his fits of anxiety, crying at night, etc. You are thinking of seeing the pediatrician/child psychiatrist but he/she is a doctor, and you are aware of the side effects of prescription drugs on children.
Scenario 2: You lost a parent 2 years ago and most of your family members and yourself have mourned your loss and have moved on. Your youngest sister, 15, is lately very depressed and has stopped going to work or socializing. You believe that she has not got over the loss of the parent.
Scenario 3: You are aware that you are using the computer / smartphone / tablet constantly. It is difficult for you to get yourself away from the LCD screen. When you’re in social events and have to turn off your phone, you feel annoyed and want to leave the place. You have feelings of guilt/shame about this.
Scenario 4: You are a successful career person. Lately you have not slept for more than 4 hours on average per night. You’re mentally exhausted, but every night you lay in bed, and your mind is racing with thoughts. You are considering taking sleeping medication.
Scenario 5: You are a college student and have recently moved out of your family home. Lately you have been feeling panic attacks in the night.
Scenario 6: Your child has been diagnosed with an illness that requires complicated medical treatment. You are worried sick. You have other children.
Scenario 7: You witnessed something traumatic (real or fiction or imagined). 6 months later, you still get nightmares and/or flashbacks.
Scenario 8: Your teenager is withdrawing from the family and his/her grades, which used to be good, are falling. You notice him/her losing excessive weight. You need someone to talk to.
Scenario 9: You are suffering pain in part(s) of your body, and the many doctors you have consulted confirm that they could find no physical clues to the causes. Doctors tell you it could be psychosomatic.
Scenario 10: Your marriage is breaking up, and you are worried that the children will be affected by the split. You want to get a divorce and you want the process to be done cordially, so that the children are spared the emotional turmoil involved in the conflict.
In all these scenarios, the services of a qualified psychotherapist can be a life-saver. These problems are not uncommon, and they happen to anyone living in this internet age we are in today. It is not to say that the internet per se has anything to do with it, but these are the kinds of problems familiar to people around the world.
What Happens in Psychotherapy?
A psychotherapist is a professional trained to be a person-in-contact with you and/or your child. As human beings we get embroiled in our daily life, unawares of the underlying emotions that drive us. These un-felt, emotions are what some of us would describe as the unconscious.
The therapist’s work is to study this aspect of your character. He/she does this by asking you questions about yourself, and checks with you at each step how you feel about certain things. The therapists also gives you feedback on your blind spots about your mannerisms, incongruences in your dialogue with him/her (for example if you contradict yourself or if your words contradict your body language, etc). The therapists holds a dialogue with you in this way and in so doing, you discover things about yourself you were not previously aware of. You also gain insights into the the situations you found yourself “stuck” in.
Above all, psychotherapists work under the rule of strict confidentiality.
Difference between psychotherapists and counselors
Psychotherapists, more so than counselors, work with your unconscious. We are interested in what drives and motivates you, and what is causing the stress responses in your lives. Psychotherapists that work with couples and families treat the individuals as part of a system. It is the unconscious forces in each member of the family that create the family dynamics. Psychotherapists believe that it is only by going deep into the emotions can we really uproot the inner conflicts behind the stress, sleeplessness, psychosomatic pain and problems that we face in our daily lives.
Most psychotherapists, unlike counselors, do not give advise (at least they try not to). Rather, the therapist will sit with you during these hours and provide you just enough support and as much support as you need to find your own resources. This way, we do not heal you, we help you make your own reparations.
Difference between psychotherapists and psychiatrists
Most Psychotherapists, unlike psychiatrists, spend more time being with you and we do not provide psycho-pharmaceutical drugs. If you are depressed, we provide do not encourage you to reach for an antidepressant (sometimes we send clients to the psychiatrist, when the client’s symptoms are severe). If you are on medication, we would ask you how it is working for you. Some clients come to us because they want to wean themselves off the drugs. This is because many psycho-pharmaceuticals are dangerous if you suddenly stop taking them.
Gestalt therapists, for example, works as your person in contact, who would guide you through your inner conflicts (which we know can feel desperate), and walk you through the experiences till you see the light again. Usually we expect to go through with you some painful experiences, thoughts and memories. We believe that it is through understanding these anxiety-causing experiences that you can find long-term peace to live again. Taking medicine alone robs you of this chance to overcome your depression in this way.
Difference between psychotherapists and psychologists
Unlike clinical psychologists, psychotherapists view the client as an individual person, builds a transpersonal relationship with you, and do not commonly see diagnosis as a main part of their work. This means that we do not see you as “a depressed patient”. We regard you as a person in relation to us who is in a mental / spiritual / emotional / social / relational situation that needs to be understood. Psychotherapists delve into the unconscious inner conflicts, looking at childhood experience and past traumatic events /illnesses that may be the cause of present afflictions. He/she sees the client as an individual with a special challenging life situation, with a unique family background, with a unique vulnerability. Most psychotherapists are trained to contain your vulnerability.
How do Psychotherapists do this?
Most licensed psychotherapists from Austria & Germany ( I can only speak for this part of the world since I am trained there) are rigorously trained for the profession. The training takes more than 6 years to complete. We are trained academically in psychology, psychopharmacology, sociology, gerontology, child and youth psychiatry, psychotherapy research, cultural anthropology, philosophy, neuroscience, ethics, sexuality and diagnostics. Over and above the academic studies we complete hundreds of hours of individual psychotherapy and group psychotherapy ourselves. We also work at least a thousand hours in psychosocial and hospital institution as interns.
How do you shop for a psychotherapist?
Use the internet and check their credentials. Psychotherapists who do not have credentials little accountability. Since you are engaging someone who is going to work with your mental suffering, it is only advisable to engage someone who is trained in a reputable institute.
Call the therapist and ask for a first interview. During this interview ask questions and you’ll have a feel if this person can help you. After a few sessions, check again.
Recommendations from friends/and other professionals do help. The best is to try the therapist out.
Characteristics of therapist to look out for:
does he/she answer your questions transparently?
do you get the impression that your concerns are being addressed?
do you get the impression that he/she is authentic in what he/she says?
do you get the impression that he/she is curious about you?
Most important thing to remember is that the therapist is a professional to serve you. In your first interview with him/her you should get impression that the therapist is more interested in knowing about you than about him/her telling you about him/herself.
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