Depression and Medication (3)

Depression is the medical condition with one of the highest prevalence rates, but also one of the costliest ones in terms of human suffering, missed work hours, higher mortality and the higher incidence of physical illnesses. First-line treatment is usually a combination of medication and psychotherapy. In milder cases, psychotherapy alone may be sufficient, while in very severe cases, psychotherapy may not be possible. Antidepressants from a number of functional families are available, with the serotonin reuptake inhibitors (SSRIs) being the mostly used ones, followed by the serotonin and norepinephrine reuptake inhibitors (SNRIs) and antidepressants from other groups. In cases of treatment resistance, an increase in the dose, or if this is not possible a switch to a different group of antidepressants may be necessary. Rarely is a combination therapy needed. Selection of an antidepressant depends on the specific symptoms, such as insomnia or reduced activity, the patient’s current situation, including pregnancy or a requirement for alertness on the job, and many other factors, including past episodes of depression and the medication history.

Keywords: depression, medication, psychiatry

 

 

For the article click here:

Depression and Medication (3) Ch Jonathan Haverkampf

 


Dr Jonathan Haverkampf, M.D. MLA (Harvard) LL.M. trained in medicine, psychiatry and psychotherapy and works in private practice for psychotherapy, counselling and psychiatric medication in Dublin, Ireland. He also has advanced degrees in management and law. The author can be reached by email at jonathanhaverkampf@gmail.com or on the website www.jonathanhaverkampf.ie.

This article is solely a basis for academic discussion and no medical advice can be given in this article, nor should anything herein be construed as advice. Always consult a professional if you believe you might suffer from a physical or mental health condition. Neither author nor publisher can assume any responsibility for using the information herein.

Trademarks belong to their respective owners. No checks have been made. 

© 2012-2017 Christian Jonathan Haverkampf. All Rights Reserved

Unauthorized reproduction and/or publication in any form is prohibited.

An Overview of Psychiatric Medication (3)

This article gives a brief overview of the main groups of psychiatric medication.

 

Keywords: medication, psychiatry

 

Click here for the article:

A Brief Overview of Psychiatric Medication (3) Ch Jonathan Haverkampf

 

 

This article is solely a basis for academic discussion and no medical advice can be given in this article, nor should anything herein be construed as advice. Always consult a professional if you believe you might suffer from a physical or mental health condition. Neither author nor publisher can assume any responsibility for using the information herein.

Trademarks belong to their respective owners. No checks have been made.

 

© 2012-2017 Christian Jonathan Haverkampf. All Rights Reserved

Unauthorized reproduction and/or publication in any form is prohibited.

Bipolar Disorder and Medication (2)

Bipolar disorder is a condition affecting an individual’s affective states (mood). The different flavors of bipolar disorder have in common that there are alterations in mood between above ‘normal’ (hypomania, mania) and normal or below normal (melancholia, depression). The other important mood disorders are the various types of depression, while mania without episodes of depressions is a rarity. The first line treatment of choice in cases of bipolar disorder is medication. However, in the long run psychotherapy has shown to be successful in making the condition more manageable for individuals suffering from it. This article presents the different types of medication used for bipolar disorder.

Keywords: bipolar disorder, medication, therapy

For the full article please click on the following link:

Bipolar Disorder and Medication (2)

Psychotherapeutic Technique: A Brief Overview

Psychotherapeutic Technique A Brief Overview (3) Ch Jonathan Haverkampf

 

Psychotherapeutic Technique: A Brief Overview

Dr Jonathan Haverkampf, M.D.

 

Introduction

When patients come to see a therapist, they often have a long list of things that do not work for them in their lives. It is easy to overlook that one of the hardest steps towards health has been taken, stepping into the office of a therapist. Psychotherapeutic Technique is then largely about helping the patient find his or her path and to have the courage to follow it. Empathy, common sense, and a good dose of optimism are helpful in this line of work, as is thinking about what is happening and has happened in the life of the patient, how they relate to themselves and the world, and that in the end everything should make sense to the head and to the heart.

The reasoning mind plays a greater role in psychotherapy than it is given credit for. Many mental health conditions arise because of what we think we have to achieve, because we think there are no alternative options or because we think we have failed. If one’s thoughts can make one feel worse, it also makes sense to look to one’s thoughts to make oneself feel better. However, the goal is not to engage in endless loops of thinking about unanswerable questions but to engage with one’s thoughts by asking whether they make sense or not.

 

Making Sense

In the best-case scenario, a patient engages in a process of ‘making sense’ with the help of the therapist. This does not just mean using logic, but seeing one’s thoughts within the context of one’s values and aspirations on one side, and one’s experiences and interactions with other people on the other side. In the end, the objectives and goals of one’s thoughts have to make sense within the context of one’s values. This ultimately leads to stable and persistent happiness and mental well-being.

Let us look at an example, which applies to many people. If one of my values is to provide a safe environment for my family, thinking about how to make more money can lead to greater happiness (and less stress), if I am aware that I am thinking about earning money to be able to buy a house that can offer my family a greater sense of security. If I see money as an end in itself, on the other hand, it can lead to an obsession, which may become endless, because I lose sight of when I have reached my goal.

In other words, life becomes easier once we see our actions and interactions with other people as something that ultimately makes sense for us. One does not need to have a specific outcome in mind. A feeling of significance to oneself is already a good starting point. Many people lack even this general feeling in most of their daily lives, which can lead to emotional disengagement, burnout, depression anxiety, panic attacks, heightened OCD, and so forth. Therapy has to bring ‘sense’ and meaning into the equation again.

 

Guided Self-Help

Much of what can happen in therapy depends on the expectations of the patient. It determines how much he or she will participate in therapy and contribute to the process in general. This makes it worthwhile to point out early to the basic working in principle in therapy, that the therapist can help patients help themselves, but should under normal circumstances not tell them what to do.

 

The Search for Meaning

Therapy is about meaning, helping a patient find relevance in things, which also asks patients to look at their fundamental values and basic interests. Following one’s values and basic interests leads to happiness and not knowing them to such conditions as anxiety and burnout. Many people in today’s busy and increasingly complex world lose their ability to see relevance in the world and in what they do. Helping people to reconnect the world as they perceive it with what they value is an important aspect of therapy. It requires the ability to communicate with oneself and between the inside and outside worlds.

 

The Therapeutic Relationship

Therapy is an exchange of information, which ultimately should help the patient to lead a happier and more fulfilling life, as well as be free from any symptoms that interfere with these goals. The motivation for it should come for a need for the feedback and information that is provided in therapy. The therapeutic relationship is the bundle of channels along which the therapeutic communication takes place.

Observation

The therapist should be able to see how patients deal with information and interact with themselves and the world around them. Better communication with oneself and others can lead to the patient feeling safer, developing greater abilities of introspection and reflection and facilitating a healthier communication with oneself and the environment. All this requires that the therapist has an understanding of the dynamics of interactions in general and of the interactions of the patient in specific, the mutual flow of information and the values, aspirations and interests everyone holds.

Empathy and Interest

Therapeutic work requires empathy and an honest and true interest in the patient and his or her inner worlds. The therapist should also have an interest for the own inner worlds and how they are are influenced by the communication of the patient. In psychoanalysis, the concepts of transference and counter-transference are used here.

Reason

Mostly therapy is about leading the patient with questions and comments to find new perspectives, open up to new information and process information in new ways. The epiphanies should take place in the patient, while the therapist can create the setting in which they take place. The motivation, ownership and integration into the own person that takes place in them is important for the success of therapy.

 

Values, Interests and Aspirations

The psychodynamic process helps to shift through derivative values and non-derivative values to get to the fundamental values which everyone holds. Here are the things which are really important to the individual, whose pursuit makes happy and life worth living for. To compromise these values causes great suffering and a loss of direction.

 

Self-Connectedness

The information to be gained from inside one’s body can be tremendous if one is willing to listen to it. We produce a lot of information in our body, which, though it requires the environment to interact with, is in many ways a very complicated self-contained system. The parallel information processing power of the nervous system and the networks of cells of the rest of the body, connected by chemical and electric pathways, is very large. Even information coming in from the outside world has to pass through cellular networks to reach higher brain centers.

Self-connectedness means being aware that the information reaching the brain is made up of information that is largely influenced by the information processed in our bodies. It requires becoming aware of the shear infinity of information sources our brain is processing, and not just the sentence one may see on a computer screen at work. This awareness is important to deal with anxiety, OCD, burnout, depression, psychosis and a host of other conditions. It does not mean one has to process all this information consciously, just that the processes are stable, while the sources and the information may change. Our values as a result of these processes change little, while our experiences on the summer vacation may be vastly different from year to year.

 

Time

To many patients, time has become convoluted. They do not know what to do with their past, are afraid to think about their feature, and are caught between past and present which deprives them of the present. Making sense of the relationship between the present, the past and the future establishes the bridges that can anchor them in the present moment. Awareness, feelings, feedback and communication are important factors in this process.

Thinking about values and interests helps to rebuild a future, but this might confront the patient with ‘bad decisions’ in the past. The best way to deal with this is through acceptance and integration. This means the past has to be accepted and to a certain extent embraced, which is an important process in therapy.

 

Questions

The most important communication tool one has in psychotherapy is to ask questions. In Socratic questioning the question can lead to insights for both, the patient and the therapist. However, to ask questions that bring greater insight requires having a sense of the type of answers that will be useful to allowing the patient greater awareness, insight and connectedness. The type of answers may often not be apparent early in therapy. However, they should be related to greater happiness, and thus a knowledge of the patient’s values, interests and aspirations.

 

Meaningful Communication

One needs to have faith that the interaction between therapist and patient will reveal the information that provides the course in treatment. And this will always happen if there is meaningful communication, which means that something new is communicated every time information travels between the two partners in the interaction. Information can be little gestures or a twitch on the forehand which signal emotions or thought processes, words that can be understood by the other person and in general every signal that can be sent and received by therapist and patient. This requirement is easy to satisfy, if there is a minimal openness to engage in a therapeutic process.

 

Types of Intervention

An intervention should create greater awareness, insight and connectedness in the patient. A few examples follow.

Questioning

“I want to be in control in social situations.”

“What does it mean to be in control in social situations?”

“I would feel free, I would not think anymore so much, I would not analyze so much what other people think.”

 

Assembling

The next step is to put together the information from the client that reaches the therapist.

“So, you are telling me that you …”

 

The Logic Test

The logical test is a result from assembling the information. Here contradictions can become clear, or spots that have not been thought about at all. These do not make up the world we imagine, but are the things that have to be overcome to get closer to one’s wished states.

 

Imagining

Imagining is that step in which people project their wishes, needs and aspirations into their inner world using building blocks they know from the real world. It is here where we build the world we compare the real world with. This comparison motivates us to change our world, but it can also raise emotions, such as fear or happiness. As emotions have influence over the worlds we imagine, so the worlds we imagine have influence over our emotions.

Our vision of the future plays an especially important role, because it can provide motivation and a sense of direction, as long as it is congruent with the person’s underlying values, aspirations and interests.

“Can you imagine what it would be like not to feel socially anxious anymore?”

 

Bridging real and imagined world

This requires looking at the changes that may have to be made in the present world to get closer to the imagined world. These thoughts should then lead to behavior changes that get the patient closer to where he/she wants to be.

 

Creating new communication pattern

Change also means we have to communicate with the world in new ways. This grows out of the rediscovered values and interests, the feedback and dynamics in the work with the therapist and the life of the patient outside the therapy. Over time, the new communication patterns should solidify as the patient is reinforced by better interactions with the environment.

 

Conclusion

Psychotherapy is both, creative and supportive work. It requires a keen eye for the process and the dynamics unfolding within a session. Working with the patient on communication patterns, interaction dynamics, uncovering values and basic interests often goes a long way towards a successful therapy.

 

 

Dr Jonathan Haverkampf, M.D. MLA (Harvard) LL.M. trained in medicine, psychiatry and psychotherapy and works in private practice for psychotherapy, counselling and psychiatric medication in Dublin, Ireland. The author can be reached by email at jonathanhaverkampf@gmail.com or on the websites www.jonathanhaverkampf.com and www.jonathanhaverkampf.ie.

This article is solely a basis for academic discussion and no medical advice can be given in this article, nor should anything herein be construed as advice. Always consult a professional if you believe you might suffer from a physical or mental health condition. Trademarks belong to their respective owners. No checks have been made.

© 2012-2017 Christian Jonathan Haverkampf. All Rights Reserved.

 

Anxiety and Panic Attacks

 

 

Anxiety and Panic Attacks (2)

Dr Jonathan Haverkampf, M.D.

 

 

Anxieties can cause incredible suffering, especially in combination with panic attacks, which are usually a short-lived but more intense form of anxiety.

 

Anxiety Disorders

Anxiety disorders are a group of mental disorders characterized by feelings of anxiety and fear. [1] Anxiety is a worry about future events and fear is a reaction to current events. These feelings may cause physical symptoms, such as a fast heart rate and shakiness. There are a number of anxiety disorders: including generalized anxiety disorder, specific phobia, social anxiety disorder, separation anxiety disorder, agoraphobia, panic disorder, and selective mutism. Often the same individual has more than one anxiety disorders, but in many cases, there might only be one type.

 

Panic Attack

The first panic attack can occur as from nowhere and the sudden sense of imminent death or literally going crazy usually comes as an enormous and sudden shock. In many cases, it has five stages:

  1. An ominous feeling of an imminent panic attack. A heightened sense of self-consciousness with beginning hyperventilation and other symptoms.
  2. The sense that there is no way to avert the full-blown panic attack.
  3. The panic attack with hyperventilation, heart palpitations, the sense of imminent doom and/or death.
  4. Alternations in the intensity of the panic attack, leading to a decline after about ten minutes.
  5. A post-panic phase in which there is a sense of exhaustion and sometimes elation that it is over.

Since the first panic attack often occurs in adolescence or young adulthood, the individual might not know what a panic attack is. In older people, panic attacks often lead to visits to the hospital emergency admission.

 

Invisibility

A feature of many anxieties and panic attacks is that they go largely unnoticed by the environment. Anxieties and panic attacks can lead to the inability to leave the house and interfere with almost every sphere of life, professional, social, and one’s relationships. When anxiety reaches into all areas of life and no longer seems specific to certain situations and locations, we call it ‘generalized’. It is then the pure form of a disturbing feeling that no longer is attached to specific object, but ‘floats freely’.

 

Loss of Control

Anxiety and Panic Attacks do not seem to be so much a fear that something happens to the world, but that one loses control somehow. Often patients mention the sense of loss of control. But it is important to turn this around. The question is why is there such a need for control in the first place? It is because there is probably a loss of something stabilizing on the inside. After all, patients usually describe the sense of losing control over themselves. This is also what maintains the vicious cycle of fear of fear, felling anxious that the anxiety might mean a total loss of control. It is important to mention that I have never seen a single case, in which someone was seriously harmed who suffered from this fear of losing control. But the feeling is there and it needs to be looked at more closely.

 

A Signal of Change

But anxieties are actually something quite interesting because they signal a necessary change if someone is willing to go a new route. The necessity for a more global change lies already in the definition of anxiety. It is not a fear of something specific, but of uncertainty itself. Communication which binds humans together is no longer felt as something really stable.

 

Fear of Imminent Death: Somatic (Body) Reaction

Panic attacks often trigger thoughts of an imminent death, such as not being able to breathe anymore or a heart attack. They frequently go along with bodily ‘fear’ reactions, such as heart palpitations and dizziness. In general, there is a general sense of a loss of control over one’s body and even one’s mind, which further worsens the panic attack. Often panic attacks start in adolescence and young adulthood and frequently they are triggered by relationship events and social situations. But if they remain untreated, they can spread out and become ‘generalized’. They can reach a point where they even occur when someone is at home lying in back or after waking up at night. In the extreme, this can lead to a situation in which a patient is not only house but also bed bound.

 

Certainty and Security

Under the surface of the symptoms of anxiety and panic attacks there often is a fear of losing a fundamental feeling of losing of certainty and security in one’s life. As babies and small children learn to rely on their interactions with others, especially primary caretakers, to meet their needs, they build up a sense of safety in regard to the world around them and a secure sense of self. As we figure out the ‘rules of daily life’ as children we learn to be reasonably in the world. Things might still be unpredictable at times, but in a caring and supportive environment surprises are seen as a fact of life that one might not be able to control, but one can learn from them and the world moves on anyway, for oneself and for everyone else.

However, if this process does not work properly for a number of reasons, a greater sense of uncertainty and a greater susceptibility to anxiety develops, especially if anxieties, OCD, panic attacks and other conditions of elevated anxiousness vis-à-vis the world and other people run in the family.

Society has developed a number of ways to deal with anxiety and reduce uncertainty. Many human endeavours aim to provide a greater sense of safety. Laws and scientific progress deal with both, uncertainty in people and uncertainty in the natural world. However, in generalized anxiety and panic attacks, it is less a certainty in the outside world than in the inside world which is really what individuals with anxiety strive for, and it is here that therapy needs to begin.

 

Meaningful Relationships

Meaningful social interactions and meaningful relationships are effective against anxiety, where it is the quality rather than the quantity which counts. The reason is that meaningful communication reconnects the individual with others, but it also aids in self-regulation and gives the individual a greater sense of being effective in taking care of oneself through the interactions with others.

 

Values and Interests

The other important element is finding not only the strength in oneself but also the direction to proceed in the life. Often there are many paths that can be taken, which confuses people and causes anxiety. Without a sense of one’s trues values, interests and aspirations it is more difficult to make the relevant decisions in life that lead to greater happiness. If one’s sense for one’s own values and fundamental interests and aspirations is compromised because of a loss of connection with one’s thinking and emotional self, stress, anxiety and burnout can ensue. It is like running in place without getting anywhere, while having a strong desire to get somewhere.

True values, part biology, part social learning from other human beings, means a fundamental belief that acting according to these values and interests and attaining one’s aspiration will really mean happiness in the long run. In anxiety, these values and fundamental interests are out of sync with our lives.

 

Inner Conflicts

Anxiety is caused by inner conflicts, which in the cognitive behavioural therapy tradition are assumed to be conscious or ‘near-conscious’, while the psychodynamic or psychoanalytic psychotherapy traditions see most of it in the domain of the unconscious. This largely explains the differences in treatment times between the two approaches, but on a theoretical level both can actually complement each other quite well. Fundamentally the causes are difficulties in communicating one’s underlying needs and wishes in a way that subjectively strengthens rather than weakens a relationship out of a fear of further loss. This also makes the internal conflicts persist. Our communication with the people in our lives has an impact on how we talk to ourselves, because they provide crucial feedback to us. When our social interactions become meaningless, our sense of shaping our world in a way that makes us feel secure and happy suffers.

 

Self-Talk

When I refer to ‘talking to oneself’ I do not mean literally talking to oneself in the street but bouncing back and forth thoughts in one’s head, observing one’s thought process and reflecting on it. This requires the exchange of highly complex information in even more complex webs of networks of nerve cells in the brain. Since our brain is a highly complex network of ever smaller networks of nerve cells it allows the brain to process information in parallel. This is the reason why we can ‘listen’ to our own thoughts. Brain cells are in contact with other brain cells and they can alter the properties of their own connections depending on the information they transmit. Medication can alter certain types of transmissions in this system, but if we want to be more specific, we have to expose ourselves to meaningful information which the brain can use to refigure itself. This is essentially what psychotherapy does. As many empirical studies have shown, psychotherapy can bring about changes in connectivity and activation of the brain, which in turn can have a lasting effect on certain conditions, such as anxieties and panic attacks.

 

Three Steps

The first step is to become aware of situations that trigger anxieties and panic attacks, such as relationship problems or work-related stress. But these problems might not always be obvious, and they might not even explain the anxiety. Problems in a relationship or shyness in social situations are normally not the ultimate explanation for anxiety or panic attacks. We need to analyse in the specific case why losing a relationship causes such threatening fears as anxieties or panic attacks suggest. Sometimes it is worthwhile taking a look into one’s past and reconstruct how an individual dealt with his or her environment as a child or adolescent and how the environment dealt with the individual. At other times it may be important to ‘dissect’ the thought patterns in the here and now and to try to find out what they could mean. “If I leave the house I might have to figure out what I really want to do in life. “If this relationship breaks up I might have to figure out what I need and what I want, who I am, who I want to be with …” and so on. This step is about better understanding one’s needs, values and aspirations, and thus oneself.

The second step is to determine if the current approach, such as avoidance or negation, is the best strategy. It always never is. But this does not mean that one has to radically alter one’s current lifestyle or social life, though in special cases it might. The actual life we have starts in our head, so it is first and foremost about determining the questions that matter and how to approach them. This is actually easier than most people think, because it is not so much about having certain answers but about learning how to think and communicate in novel ways. Change usually means widening one’s mental repertoire, not narrowing it. The more effective tools are in our toolbox and the more meaningful information we have access to, the better will be our answers and decisions.

The third step is to act according to this novel information. This might sound like a tall order in the face of fears, anxieties and panic attacks, but once someone reaches this stage, the hurdles are often diminished or gone altogether. The fears usually disappear during the first and the second step. The reason is that we are usually more afraid of an uncertain ill-defined event than a certain defined event. When you are facing a threatening event, the uncertainty about an unlikely ill-defined outcome can be more painful than the certainty about a certain well-defined event. The certainty of death does not disturb people nearly as much as not knowing how they will die.

 

Happiness

The goal is not absolute certainty in life but the attainment of happiness. Anxiety does not necessarily mean a shift in the balance between happiness and writing a meaningful story for one’s life, rather, it often is a wake-up call for us to re-evaluate who we are and what we really want in life to make us happier.

 

Most people want to lead lives which feel true to themselves for the simple reason that they believe it will make them happy. The only certainty that really helps against anxiety is the certainty that one follows one’s own path. To help a patient reach this path and follow it with confidence is an important objective of psychotherapy and counselling.

 

 

 

 

References

[1] Diagnostic and Statistical Manual of Mental Disorders. American Psychiatric Association (5th ed.). Arlington: American Psychiatric Publishing. 2013. pp. 189–195. ISBN 978-0890425558.

 

 

 

Dr Jonathan Haverkampf, M.D. MLA (Harvard) LL.M. trained in medicine, psychiatry and psychotherapy and works in private practice for psychotherapy, counselling and psychiatric medication in Dublin, Ireland. The author can be reached by email at jonathanhaverkampf@gmail.com or on the websites www.jonathanhaverkampf.com and www.jonathanhaverkampf.ie.

This article is solely a basis for academic discussion and no medical advice can be given in this article, nor should anything herein be construed as advice. Always consult a professional if you believe you might suffer from a physical or mental health condition. Trademarks belong to their respective owners. No checks have been made.

© 2012-2017 Christian Jonathan Haverkampf. All Rights Reserved.

 

Psychotherapeutic Technique: An Overview

Psychotherapeutic Technique A Brief Overview (2) Ch Jonathan Haverkampf

 

Psychotherapeutic Technique: A Brief Overview

Dr Jonathan Haverkampf, M.D

 

Introduction

When patients come to see a therapist, they often have a long list of things that do not work for them in their lives. It is easy to overlook that one of the hardest steps towards health has been taken, stepping into the office of a therapist. Psychotherapeutic Technique is then largely about helping the patient find his or her path and to have the courage to follow it. Empathy, common sense, and a good dose of optimism are helpful in this line of work, as is thinking about what is happening and has happened in the life of the patient, how they relate to themselves and the world, and that in the end everything should make sense to the head and to the heart.

 

Guided Self-Help

Much of what can happen in therapy depends on the expectations of the patient. It determines how much he or she will participate in therapy and contribute to the process in general. This makes it worthwhile to point out early to the basic working in principle in therapy, that the therapist can help patients help themselves, but should under normal circumstances not tell them what to do.

 

The Search for Meaning

Therapy is about meaning, helping a patient find relevance in things, which also asks patients to look at their fundamental values and basic interests. Following one’s values and basic interests leads to happiness and not knowing them to such conditions as anxiety and burnout. Many people in today’s busy and increasingly complex world lose their ability to see relevance in the world and in what they do. Helping people to reconnect the world as they perceive it with what they value is an important aspect of therapy. It requires the ability to communicate with oneself and between the inside and outside worlds.

 

The Therapeutic Relationship

Therapy is an exchange of information, which ultimately should help the patient to lead a happier and more fulfilling life, as well as be free from any symptoms that interfere with these goals. The motivation for it should come for a need for the feedback and information that is provided in therapy. The therapeutic relationship is the bundle of channels along which the therapeutic communication takes place.

Observation

The therapist should be able to see how patients deal with information and interact with themselves and the world around them. Better communication with oneself and others can lead to the patient feeling safer, developing greater abilities of introspection and reflection and facilitating a healthier communication with oneself and the environment. All this requires that the therapist has an understanding of the dynamics of interactions in general and of the interactions of the patient in specific, the mutual flow of information and the values, aspirations and interests everyone holds.

Empathy and Interest

Therapeutic work requires empathy and an honest and true interest in the patient and his or her inner worlds. The therapist should also have an interest for the own inner worlds and how they are are influenced by the communication of the patient. In psychoanalysis, the concepts of transference and counter-transference are used here.

Reason

Mostly therapy is about leading the patient with questions and comments to find new perspectives, open up to new information and process information in new ways. The epiphanies should take place in the patient, while the therapist can create the setting in which they take place. The motivation, ownership and integration into the own person that takes place in them is important for the success of therapy.

 

Values, Interests and Aspirations

The psychodynamic process helps to shift through derivative values and non-derivative values to get to the fundamental values which everyone holds. Here are the things which are really important to the individual, whose pursuit makes happy and life worth living for. To compromise these values causes great suffering and a loss of direction.

 

Self-Connectedness

The information to be gained from inside one’s body can be tremendous if one is willing to listen to it. We produce a lot of information in our body, which, though it requires the environment to interact with, is in many ways a very complicated self-contained system. The parallel information processing power of the nervous system and the networks of cells of the rest of the body, connected by chemical and electric pathways, is very large. Even information coming in from the outside world has to pass through cellular networks to reach higher brain centers.

Self-connectedness means being aware that the information reaching the brain is made up of information that is largely influenced by the information processed in our bodies. It requires becoming aware of the shear infinity of information sources our brain is processing, and not just the sentence one may see on a computer screen at work. This awareness is important to deal with anxiety, OCD, burnout, depression, psychosis and a host of other conditions. It does not mean one has to process all this information consciously, just that the processes are stable, while the sources and the information may change. Our values as a result of these processes change little, while our experiences on the summer vacation may be vastly different from year to year.

 

Time

To many patients, time has become convoluted. They do not know what to do with their past, are afraid to think about their feature, and are caught between past and present which deprives them of the present. Making sense of the relationship between the present, the past and the future establishes the bridges that can anchor them in the present moment. Awareness, feelings, feedback and communication are important factors in this process.

Thinking about values and interests helps to rebuild a future, but this might confront the patient with ‘bad decisions’ in the past. The best way to deal with this is through acceptance and integration. This means the past has to be accepted and to a certain extent embraced, which is an important process in therapy.

 

Questions

The most important communication tool one has in psychotherapy is to ask questions. In Socratic questioning the question can lead to insights for both, the patient and the therapist. However, to ask questions that bring greater insight requires having a sense of the type of answers that will be useful to allowing the patient greater awareness, insight and connectedness. The type of answers may often not be apparent early in therapy. However, they should be related to greater happiness, and thus a knowledge of the patient’s values, interests and aspirations.

 

Meaningful Communication

One needs to have faith that the interaction between therapist and patient will reveal the information that provides the course in treatment. And this will always happen if there is meaningful communication, which means that something new is communicated every time information travels between the two partners in the interaction. Information can be little gestures or a twitch on the forehand which signal emotions or thought processes, words that can be understood by the other person and in general every signal that can be sent and received by therapist and patient. This requirement is easy to satisfy, if there is a minimal openness to engage in a therapeutic process.

 

Types of Intervention

An intervention should create greater awareness, insight and connectedness in the patient. A few examples follow.

Questioning

“I want to be in control in social situations.”

“What does it mean to be in control in social situations?”

“I would feel free, I would not think anymore so much, I would not analyze so much what other people think.”

 

Assembling

The next step is to put together the information from the client that reaches the therapist.

“So, you are telling me that you …”

 

The Logic Test

The logical test is a result from assembling the information. Here contradictions can become clear, or spots that have not been thought about at all. These do not make up the world we imagine, but are the things that have to be overcome to get closer to one’s wished states.

 

Imagining

Imagining is that step in which people project their wishes, needs and aspirations into their inner world using building blocks they know from the real world. It is here where we build the world we compare the real world with. This comparison motivates us to change our world, but it can also raise emotions, such as fear or happiness. As emotions have influence over the worlds we imagine, so the worlds we imagine have influence over our emotions.

Our vision of the future plays an especially important role, because it can provide motivation and a sense of direction, as long as it is congruent with the person’s underlying values, aspirations and interests.

“Can you imagine what it would be like not to feel socially anxious anymore?”

 

Bridging real and imagined world

This requires looking at the changes that may have to be made in the present world to get closer to the imagined world. These thoughts should then lead to behavior changes that get the patient closer to where he/she wants to be.

 

Creating new communication pattern

Change also means we have to communicate with the world in new ways. This grows out of the rediscovered values and interests, the feedback and dynamics in the work with the therapist and the life of the patient outside the therapy. Over time, the new communication patterns should solidify as the patient is reinforced by better interactions with the environment.

 

Conclusion

Psychotherapy is both, creative and supportive work. It requires a keen eye for the process and the dynamics unfolding within a session. Working with the patient on communication patterns, interaction dynamics, uncovering values and basic interests often goes a long way towards a successful therapy.

 

 

Dr Jonathan Haverkampf, M.D. MLA (Harvard) LL.M. trained in medicine, psychiatry and psychotherapy and works in private practice for psychotherapy, counselling and psychiatric medication in Dublin, Ireland. The author can be reached by email at jonathanhaverkampf@gmail.com or on the websites www.jonathanhaverkampf.com and www.jonathanhaverkampf.ie.

This article is solely a basis for academic discussion and no medical advice can be given in this article, nor should anything herein be construed as advice. Always consult a professional if you believe you might suffer from a physical or mental health condition. Trademarks belong to their respective owners. No checks have been made.

© 2012-2017 Christian Jonathan Haverkampf. All Rights Reserved.

 

Schools of Psychotherapy

CBT and Psychodynamic Psychotherapy – A Comparison Ch Jonathan Haverkampf

Cognitive Behavioural Therapy (CBT) and psychodynamic psychotherapy, the less intensive form of psychoanalysis, are arguably the most prominent and well-researched schools of psychotherapy (see Lambert and Bergin, 1994), apart from interpersonal therapy (IPT) models.

Essentially all psychotherapies go back to the revolutionary concept of the ‘talking cure’[1] in the late nineteenth century, the use of communication as an instrument of healing. CBT and psychodynamic psychotherapy as descendants from the same concept should be viewed as complimentary rather than as substitutes. Technical approaches from both can be helpful in individual situations.

The aim of psychotherapy is not merely to eliminate suffering (WHO, 1946), but to help patients develop as humans. The primary tool is communication, in CBT to provide information that generates change and in psychodynamic psychotherapy to reveal the information that brings about change.  There are synergistic effects from using both. Zipfel et al (2014) showed in a large sample of anorexic patients, that CBT was associated with weight gain, while psychodynamic psychotherapy with lower relapse rates at the 12-month follow-up. McFall and Wollersheim (1979) in an early study successfully used a combination of CBT and psychodynamic psychotherapy in anxiety[1]. Given the widely-perceived need for multimodal approaches[2], it is difficult to comprehend that this should not apply to the most important therapeutic models we have. In ancient Greece, knowing oneself (γνῶθι σεαυτόν, “know thyself”) and the process of the Socratic dialogue were inextricably linked. Psychodynamic psychotherapy and CBT should be viewed as complementary rather than substitutes.

[1] The objective was to “modify their unrealistic cognitive appraisals of threat” (cognitive), “test the validity of their fears” (behavioural), and “realize resources … for coping with uncertainty and anxiety” (psychodynamic).

[2] A multimodal approach with intensive psychotherapy, medication, and psychosocial rehabilitation has repeatedly been shown to yield superior outcomes (see, for example, Saxena et al, 2002, Greist et al, 2003).

[1] Breuer et al, 2000

Parenting a Child with OCD

This article contains some tips on how to parent a Child with OCD. It does not go into the depths of OCD, but contains some advice to help parents feel more relaxed about the OCD of their children.

5 Tips on How to Parent a Child with OCD on PsychCentral(R)