brookhaven hospital august 1, 2012 “the case for psychotherapy” dennis cavenah, ms, lpc, lmft,...

BROOKHAVEN HOSPITALAUGUST 1, 2012

“THE CASE FOR PSYCHOTHERAPY”

DENNIS CAVENAH, MS, LPC, LMFT, CEAP

THE CASE FOR PSYCHOTHERAPY

Psychotherapy: Licensed Health Care Providers: Licensed Professional Counselors LPC Licensed Behavioral Therapist LBP Licensed Marital & Family Counselors LMFT Licensed Social Workers LCSW Licensed Alcohol & Drug Counselor LADC MD Specialty In Psychiatry RN with Psychiatric Training

THE CASE FOR PSYCHOTHERAPY

Therapy & Your Brain:

Involves the Limbic System & Prefrontal Cortex

Limbic = memory & emotion

Prefrontal Cortex = planning, judgment, self-control

THE CASE FOR PSYCHOTHERAPY

Psychotherapist Practice:

Neuroscience?

Rumpelstilskin Affect

Voodoo?

Witch Doctors?

Shamans?

THE CASE FOR PSYCHOTHERAPY

What psychiatric disorders benefit from psychotherapy treatments??????

Phobias Obsessive-Compulsive Disorders Depression Bi-Polar Disorder (Whatever that means!!) Addictions Anxiety Disorders Panic Disorders Ptsd

THE CASE FOR PSYCHOTHERAPY When are Antidepressants Better Than

Psychotherapy?

2005 DeRubeis et al., study of 240 patients: 1. Pts. On Anti-depressant got better quicker. 2. Pts. Cognitive therapy worked as well as

antidepressant therapy on moderate to severe depression.

3. @ 16 weeks 58% of both groups were better. 4. Pts. Who quit Paxil after 16 weeks relapse

rate twice that of psychotherapy patients. 5. Concluded psychotherapy more effective and

less costly in long run.

THE CASE FOR PSYCHOTHERAPY

SSRIs vs. Placebo

2005 Arrol et. Al., based on 15 studies concluded:

1. Adults responded to 56% to 60% to antidepressants.

2. compared to 42% to 47% for placebo. 3. 40% to 44% did not improve at all.!!!!!! 4. Concluded only 13 to 18% actually benefited

from antidepressant treatment.

THE CASE FOR PSYCHOTHERAPY

2000, VHA-DOD; Veterans Health Administration of Department of Defense.

1. Pharmacotherapy & psychotherapy recommended for tx. of moderate to severe depression.

2. Mild to moderate depression with a motivated patient psychotherapy is warranted,

THE CASE FOR PSYCHOTHERAPY

THE CASE FOR PSYCHOTHERAPY

Effective Therapist Vs. Ineffective Therapists (?)1. 1. Professional training is of little importance.2. 2. Years of experience have little impact.3. 3. Little difference in theoretical training.4. 4. Have more positive alliance with their pts.5. 5. “Master Therapists”; emotionally receptive,

psychologically healthy, good relationship skills.

6. 6. Some differences in understanding clinical materials, greater complex cognitive skills, have curiosity in difficult cases.

THE CASE FOR PSYCHOTHERAPY

The Psychotherapist as a Neuroscientist A Safe and Emphatic Relationship The Importance of Stress The Importance of Language(co-construction

of narratives) Language of Therapeutic Alliance: 1. Reflexive Social language. 2. Internal language. 3. Self-Reflection.

THE CASE FOR PSYCHOTHERAPY

The positive affects of psychotherapy on the treatment of depression.

Identify distorted thinking patterns.

Understand everyday circumstances and events.

Regain a sense of control and pleasure in life.

Explore behaviors that might contribute to a low mood.

THE CASE FOR PSYCHOTHERAPY

Treatments for PTSD: returning soldiers, etc.

Exposure Based Therapya) In Vivo-Imaginal Therapya. Systematic Desensitization

Cognitive Therapy

Anxiety Management Therapy

++EMDR vs. CBTCBT significantly better treatment for PTSD (Deville &

Spence 1999)

THE CASE FOR PSYCHOTHERAPY

Shared common feature of most psychotherapists

1. An office, designated to help with emotional distress; i.e., “edifice complex,” diplomas etc.

2. The client and the therapist have well defined roles.

3. A conceptual scheme or theoretical system to explain a client’s suffering.

4. The therapists conceptual scheme which drives the treatment procedure both participate in.

THE CASE FOR PSYCHOTHERAPY

THE BUY IN

1. Psycho-education.

2. Define the diagnosis vs. the problem.

3. Review the tx. Methods, referrals.

4. Coordination of care letter to other tx. Providers. 5. Written material to review.

THE CASE FOR PSYCHOTHERAPY

TRUTH OR MYTHS

Therapists can predict behavior. Therapists are experts. Therapists have inherit intuition. Therapists years of experience make them

better. Therapist can use diagnosis and prediction

for future behavior. Licensing protects the public.

THE CASE FOR PSYCHOTHERAPY

DEPRESSION FACTS: 1. 4TH LARGEST MEDICAL PROBLEM IN THE

WORLD. 2. TREATMENT COSTS ESTIMATED $50

BILLION 3. 50% CTS. WITH SEVERE DEPRESSION DO

NOT RESPOND TO ANTI-DEPRESSANT MEDICATIONS.

4. MULTIPLE STUDIES INDICATE CBT MORE EFFECTIVE THAT ANTI-DEPRESSANT EVEN WITH SEVERE OR VEGETATIVE DEPRESSION.

THE CASE FOR PSYCHOTHERAPY

DEPRESSION FACTS: 5. 1ST LINE TREATMENT FOR MOST PTS. IS

MEDICATION, RX. PCP. 6. HIGHER RELAPSE RATE WITH THOSE TX.

WITH ANTI-DEPRESSANTS ONLY. 7. AVERAGE LENGTH OF DEPRESSION

UNTREATED = 8 MONTHS. 8. DEPRESSION IS NOT A RESULT OF “CHEMICAL IMBALANCE.” 9. ANTI-DEPRESSANTS DO NOT TX.

DEPRESSION ONLY TX. SYMPTOMS.

THE CASE FOR PSYCHOTHERAPY

10. RELAPSE RATE CONNECTED TO SIDE AFFECTS OF MEDICATIONS.

11.TAKES 6 WEEKS FOR MEDICATIONS TO WORK MINIMUM LENGTH OF TX. WITH MEDICATIONS IS 6 MONTHS.

12. PTS. TX. ONLY WITH MEDICATIONS HAVE A 80% CHANCE OF RELAPSE.

13. COMBINATION OF PSYCHOTHERAPY AND MEDICATIONS WORKS WELL WITH SOME DEPRESSION.

THE CASE FOR PYSCHOTHERAPY

References: Antonuccio, David O., Danton, William G., & DeNelsky, Garland Y. Psychotherapy Versus

Medication for Depression: Challenging the Conventional Wisdom With Data Professional Psychology: Research and Practice. December 1995 Vol.26, No. 6, 574-585.

Kirsch I, Moore TJ, Scoboria A, Nicholls SS (2002) The emperor's new drugs: an analysis of antidepressant medication data submitted to the U.S. Food and Drug Administration. Prev Treat. 5. article 23. Available: Accessed 15 July 2002.

Frank & Frank, “Persuasion and Healing, A Comparative Study of Psychotherapy, 3rd Edition, 1993.

Fancher, Robert T. Cultures Of Healing, 1995.

Lilienfeld, Lynn, Lohr, Ed., Science & Pseudoscience in Clinical Psychology, 2003.

Dawes, Robin, House of Cards, “Psychology & Psychotherapy Built on myth, 1996

Cozolino, Louis, The Neuroscience of Psychotherapy, 2002

Torrey EF. Witchdoctors and Psychiatrists - The Common Roots of Psychotherapy and Its Future. revised ed. New York: Harper & Row, 1986.