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BROOKHAVEN HOSPITAL AUGUST 1, 2012 “THE CASE FOR PSYCHOTHERAPY” DENNIS CAVENAH, MS, LPC, LMFT, BROOKHAVEN HOSPITAL AUGUST 1, 2012 “THE CASE FOR PSYCHOTHERAPY” DENNIS CAVENAH, MS, LPC, LMFT, CEAP

THE CASE FOR PSYCHOTHERAPY Ø Psychotherapy: Licensed Health Care Providers: Licensed Professional Counselors LPC THE CASE FOR PSYCHOTHERAPY Ø 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: Ø Involves the Limbic System & THE CASE FOR PSYCHOTHERAPY Therapy & Your Brain: Ø Involves the Limbic System & Prefrontal Cortex Ø Limbic = memory & emotion Ø Prefrontal Cortex = planning, judgment, selfcontrol Ø

THE CASE FOR PSYCHOTHERAPY Psychotherapist Practice: Neuroscience? Rumpelstilskin Affect Voodoo? Witch Doctors? Shamans? 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 THE CASE FOR PSYCHOTHERAPY What psychiatric disorders benefit from psychotherapy treatments? ? ? Phobias q Obsessive-Compulsive Disorders q Depression q Bi-Polar Disorder (Whatever that means!!) q Addictions q Anxiety Disorders q Panic Disorders q Ptsd q

THE CASE FOR PSYCHOTHERAPY When are Antidepressants Better Than Psychotherapy? 2005 De. Rubeis et THE CASE FOR PSYCHOTHERAPY When are Antidepressants Better Than Psychotherapy? 2005 De. Rubeis 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 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. 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

THE CASE FOR PSYCHOTHERAPY Effective Therapist Vs. Ineffective Therapists (? ) 1. 1. Professional 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 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. Ø Ø Ø Ø

THE CASE FOR PSYCHOTHERAPY The positive affects of psychotherapy on the treatment of depression. 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. v Exposure Based Therapy THE CASE FOR PSYCHOTHERAPY Treatments for PTSD: returning soldiers, etc. v Exposure Based Therapy a) a. In Vivo-Imaginal Therapy Systematic Desensitization Cognitive Therapy Anxiety Management Therapy ++EMDR vs. CBT significantly better treatment for PTSD (Deville & Spence 1999)

THE CASE FOR PSYCHOTHERAPY Shared common feature of most psychotherapists 1. An office, designated 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. The client and therapist have well defined roles. A conceptual scheme or theoretical system to explain a client’s suffering. The therapists conceptual scheme which drives the treatment procedure both participate in. 2. 3. 4.

THE CASE FOR PSYCHOTHERAPY THE BUY IN 1. Psycho-education. 2. Define the diagnosis vs. 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. 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. 4 TH LARGEST MEDICAL PROBLEM IN THE THE CASE FOR PSYCHOTHERAPY DEPRESSION FACTS: 1. 4 TH 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. 1 ST LINE TREATMENT FOR MOST PTS. THE CASE FOR PSYCHOTHERAPY DEPRESSION FACTS: 5. 1 ST 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. 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. , & THE CASE FOR PYSCHOTHERAPY References: Antonuccio, David O. , Danton, William G. , & De. Nelsky, 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, 3 rd 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.