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Taking the Pulse of Psychotherapy

There’s been a decline in the public’s utilization of psychotherapy as a consequence of the rise of what might be called the Gang of Three: DSM, Big Pharma, and Managed Care. Today, we appear to be an atomized and poorly organized field that’s lost economic ground to other approaches promising mental health consumers improved wellbeing. But while recognizing the missed opportunities and missteps we’ve made as a profession, the contributors to our latest issue of the Networker also point to what we need to do to make a more concerted and effective stand to reclaim lost territory.
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How Effective is Modern Psychotherapy?

Over the past few decades, therapy has made great strides. However, there are areas in which I think therapy may have also gotten worse. The essence of therapy remains the relationship, and the greatest gift to a client with virtually any problem is a focused, curious, empathic listener. But right now, pressure to speed up therapy can undercut the sanctity of the therapeutic relationship. Like good cooking, I think good therapy takes time. In many ways, we’re treating people in therapy offices as if it were 1960. But it’s a really different time, and there are a lot of issues we’re not approaching because we don’t know how.   Read More

How Our Everyday Behavior Can Heal Trauma

As therapists, we often elicit negative emotions, believing that they must be purged before there’ll be room for hope and other positive emotions. We’re particularly anxious to assuage trauma survivors, whose desperate, unbearable pain seems to demand immediate relief. But favoring positive emotions and subtly trying to subdue negative ones can backfire. How do we get beyond this impasse? We can begin by looking again at the ways people have found consolation and support in the thousands of years before psychotherapy was developed. Throughout history, human beings have found rough relief and a modicum of comfort in the immediate obligations and habits of ordinary, daily life.   Read More

Childhood ADHD and the Prescription Drug Rush

Doctors, especially psychiatrists, have been changing their view of children’s problems since the 1970s. Before then, based on the Freudian model, Johnny’s problems were considered the result of inner conflicts generated primarily by his relationship with his mother. But in 1980, with the publication of DSM-III, a new concept—for most psychiatric conditions, including ADHD—was announced. The diagnosis of ADHD and the use of drugs like Ritalin rose at rates never before seen in this country—or anywhere else, for that matter. The year 1991 marked a veritable sea change—a social movement began that changed the way our society views children’s misbehavior and underperformance.   Read More

Can Couples Therapy Work with Only One Partner?

Many therapists define the type of therapy they practice by taking a head count: if one person is present, they’re practicing individual therapy; if two or more people are present, it’s couples or family therapy. I believe this is misguided. The key to determining which brand of therapy is in use at any given point lies in the therapist’s orientation and focus, not the number of people occupying space in the room. In contrast to therapists who question the value of doing couples therapy with individuals, this approach is often my method of choice for a variety of reasons. I find it can empower people by showing them that they no longer have to play the waiting game of “I’ll change if you change first.” Instead, they find themselves back in the driver’s seat of their own lives.   Read More

Assessing the State of Psychotherapy

The bad news was made official in 2010, though everybody in the head-shrink business had long suspected as much: psychotherapy was in decline, or even in freefall. You might think this trend represents people’s preferences for the quick fix of a pill, rather than a slog through talk therapy, but you’d be wrong: surveys have consistently shown that depressed and/or anxious people and their families would rather talk to a real, live, human therapist than fill a prescription. So in what appears to be the twilight of the psychopharm gods, why aren’t therapy practitioners rising up, throwing off their chains, and reconquering lost mental health territory?   Read More

Hypnotic Language in the Consulting Room

As therapists, we must recognize the complexity and ambivalence at the core of human experience. People run into problems when their lives are dictated by rigid beliefs that make the stories they’re living out too restrictive, for example: “I must always be perfect,” or “I should always smile and be happy.” But permission counters these commands and prohibitions. The therapist who offers permission goes beyond accepting clients as they are and moves into encouraging them to expand their life stories and their sense of themselves.   Read More

Overcoming Depression Using a Mind-Body Approach

When we’re faced with a crisis, or when we’re emotionally crashing, and there’s no time to gather our thoughts, mindfulness can seem like a hopeless luxury, impossible to achieve. The program for depression my colleagues Mark Williams and John Teasdale and I developed, Mindfulness-Based Cognitive Therapy (MBCT), integrates the eight-week group approach of MBSR with basic principles of cognitive therapy. The act of observing our bodies is good training for when we feel bad—anxious or depressed—because it gives us a kind of emotional detachment, which acts as a stable emotional platform, preventing us from being overwhelmed by our feelings.   Read More

Therapy’s Strategies for Sleep Disorders

Traditionally, sleep and darkness have had positive connotations. Yet many of us don’t go gently into the night: we knock ourselves out with alcohol, sleeping pills, or sheer exhaustion. Our widespread fear of and disregard for darkness—both literal and figurative—may be the most critical, overlooked factor in the contemporary epidemic of sleep disorders. We suffer today from serious complications of a kind of psychological “nightblindness”: a far-reaching failure to understand the significance of night and darkness to our health and well-being.   Read More

Where Do Therapists Stand on Marijuana Legalization?

More than 20 states have enacted laws to allow the sale of marijuana for medicinal purposes, and others have moved to reduce criminal penalties for possession of small amounts. But the more marijuana legalization reaches mainstream acceptance, the more the divisions of opinion within the mental health field—presumably the professionals who have the most scientifically informed perspective on the debate—become apparent.   Read More

Therapeutic Mindfulness in an Age of Interruption

We speak about “the present moment” and the ability to be fully present, and we claim a sort of smudgy understanding of what that means. But what is “the present moment?” Americans have heard and used these phrases for about 40 years, as Eastern and New Age concepts influenced psychology and other ologies. But obviously, once you delve into it, now isn’t as exact a word as it appears. Plus, it isn’t so easy to “live now” in a multimedia, interactive era of cell phones and pagers in which we’re expected to be constantly available. To buck the odds takes courage.   Read More

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