Category Archives: Mental Health

May 24

Short-Term Therapy Vs. Long-Term Therapy

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Is short-term therapy better than long-term therapy? Or is it vice versa?

It depends who you’re asking.

If it’s clients, on one end of the continuum are those who prefer the briefest of therapies (à la Bob Newhart‘s “stop it!”)—or even no therapy at all—while, on the other end are those who love having a therapist to see over the course of their lifetime, if not continuously at least on an as-needed basis.

But then there’s the money factor. For some without means (underinsured, uninsured, or unable to pay) it doesn’t feel like a choice: short-term therapy is a cost-saver and therefore preferable.

Enrico Gnaulati‘s Saving Talk Therapy: How Health Insurers, Big Pharma, and Slanted Science are Ruining Good Mental Health Care (2018) cites a number of other factors that work against longer-term therapy. They include Big Pharma‘s pushing of psychotropic medications directly to consumers via TV and other ads, the ability to get such medications from one’s physicians versus having to see a mental health practitioner, and the fact that health insurers push quicker treatments (again, the money issue).

Gnaulati believes (Psychology Today) talk therapy is “seriously under threat; at least as it applies to varieties of talk therapy that are relatively non-directive, time-intensive, in-depth, and exploratory in nature—typically under the psychodynamic and humanistic umbrellas of care.”

The newer trend, indeed, is to provide “evidence-based” treatments, which according to Gnaulati are “CBT-type, short-term psychotherapies supposedly tailored to reduce the symptoms associated with a given diagnosis.” He regards the studies that tout such treatments as somewhat misleading, however:

Evidenced-based treatments such as these are problematic because they measure progress strictly in terms of symptom reduction over the short term, not greater social and emotional well-being over the long term.
It turns out that evidenced-based really is evidenced-biased because the bulk of current empirical evidence substantiates that ‘contextual factors’ in psychotherapy are most predictive of positive outcome—empathy, genuineness, a strong working alliance, good rapport, favorable client expectations. And when you survey clients they overwhelmingly want a therapist who is ‘a good listener’ and who has a ‘warm personality,’ not someone skilled in the latest techniques.  So, CBT-type evidenced-based treatments should not be monopolizing the field right now in the way they are.

Whether shorter or longer, talk therapy, I agree, does need to be saved. “Fifteen Facts About Mental Health That Show Why We Need to Save Talk Therapy” was posted by Gnaulati’s publisher, Beacon Press. A sampling:

  • 90% of people claim they would rather meet with a therapist to talk about their problems than take medications.
  • Only about 3% of Americans ever enter psychotherapy, even though roughly half the population meet lifetime criteria for a serious emotional problem.
  • Of the approximately 49,000 psychiatrists in the United States, the vast majority exclusively prescribe medications. Fewer than 11% provide talk therapy to their patients.
  • 58% of emotionally troubled people take medications only, with no psychotherapy. About 10% of emotionally troubled people attend psychotherapy only and opt out of medication usage.
  • 50% of research articles in the field of psychiatry are ghostwritten in some shape or form, penned by outsiders and published under the names of prominent academics, all whom draw paychecks from pharmaceutical companies.

In sum, as a talk therapist myself, I don’t believe one size (of therapy) fits all. Medications may be all some people need, while others may need to talk things out, some over a longer period than others. When talk therapy is the choice, the relationship between each particular therapist and client is what often matters the most. And last but not least, money should not have to be an issue—needed therapy should be made affordable for all.

May 17

Happiness: Quotes from the Experts

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I use the term happiness to refer to the experience of joy, contentment, or positive well-being, combined with a sense that one’s life is good, meaningful, and worthwhile. Sonja Lyubomirsky, The How of Happiness, on finding happiness

Finding happiness is a preoccupation for many. The following quotes from various authors and experts may help point you in the right direction.

Jonathan Haidt, The Happiness Hypothesis: Happiness is not something that you can find, acquire, or achieve directly. You have to get the conditions right and then wait. Some of those conditions are within you, such as coherence among the parts and levels of your personality. Other conditions require relationships to things beyond you: Just as plants need sun, water, and good soil to thrive, people need love, work, and a connection to something larger. It is worth striving to get the right relationships between yourself and others, between yourself and your work, and between yourself and something larger than yourself. If you get these relationships right, a sense of purpose and meaning will emerge.

Matthieu Ricard, Happiness: Happiness is a state of inner fulfillment, not the gratification of inexhaustible desires for outward things.

Sonja Lyubomirsky, The How of Happiness: If we observe genuinely happy people, we shall find that they do not just sit around being contented. They make things happen. They pursue new understandings, seek new achievements, and control their thoughts and feelings. In sum, our intentional, effortful activities have a powerful effect on how happy we are, over and above the effects of our set points and the circumstances in which we find themselves. If an unhappy person wants to experience interest, enthusiasm, contentment, peace, and joy, he or she can make it happen by learning the habits of a happy person.

Raj Raghunathan, author of If You’re So Smart, Why Aren’t You Happy? in an interview with Joe Pinsker, The Atlantic: On the one hand, we are hard-wired to focus more on negative things. But at the same time, we are also all hard-wired to be seeking a sense of happiness and the desire to flourish, and to be the best we can be. Ultimately, what we need in order to be happy is at some level pretty simple. It requires doing something that you find meaningful, that you can kind of get lost in on a daily basis.

Paul Dolan, Happiness By Design: Change what you do, not how you think. You are what you do, your happiness is what you attend to, and you should attend to what makes you and those whom you care about happy.

David Steindl-Rast, Music of Silence: Look closely and you will find that people are happy because they are grateful. The opposite of gratefulness is just taking everything for granted.

Gretchen Rubin, The Happiness Project: The belief that unhappiness is selfless and happiness is selfish is misguided. It’s more selfless to act happy. It takes energy, generosity, and discipline to be unfailingly lighthearted, yet everyone takes the happy person for granted. No one is careful of his feelings or tries to keep his spirits high. He seems self-sufficient; he becomes a cushion for others. And because happiness seems unforced, that person usually gets no credit.

Sonja Lyubomirsky, The How of Happiness: To be sure, most of us do become happier at some point during our lives. Indeed, contrary to popular belief, people actually get happier with age.

Daniel M. Gilbert, Stumbling on Happiness: We are happy when we have family, we are happy when we have friends and almost all the other things we think make us happy are actually just ways of getting more family and friends.

May 10

How to Change Habits: Five Books

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The following five nonfiction books about how to change habits, listed from newest to oldest, are recommended reading.

I. Wendy Wood, Good Habits, Bad Habits: The Science of Making Positive Changes That Stick (2019)

Author Adam Grant calls Wood, a long-time researcher on this subject, “the world’s leading expert” on this subject.

A key quote from Wood: “On average, it takes us sixty-six days of repeating a simple health behavior until it becomes automatic. In other words, identify a new behavior, do it repeatedly for two months and a week, and it will become a habit.”

The Kirkus Reviews summary states, Wood “notes that the same learning mechanisms responsible for bad habits also control good ones.” An example given: exercising and cigarette smoking. How one winds up choosing either activity and how one engages in either repeatedly is also the key to how to produce change.

II. BJ Fogg, Tiny Habits: The Small Changes That Change Everything (2019)

Fogg professes that “only 3 things will change your behavior in the long term”:

Option A:  Have an epiphany
Option B:  Change your environment
Option C:  Take baby steps

However. Spoiler Alert! Epiphanies are extremely hard to come by, so B and C are really your options. It’s all spelled out in Tiny Habits, but he also offers a free five-day program on how to change habits; click on https://tinyhabits.com/join.

III. Sean D. Young, Stick With It: A Scientifically Proven Process for Changing Your Life–for Good (2017)

Young states, “Fortunately, you don’t need to change who you are as a person to make change last. You just need to understand the science behind lasting change and how to create a process that fits who you are.”

The Stages of Change Model developed in the 1970’s and 80’s by James O. Prochaska and Carlo DiClemente began with studying smokers’ attempts to give up their habit. The end result was the development of a tool to assess one’s readiness to work on change of any kind as well as one’s readiness to stick with it, or to persevere.

IV. Gretchen Rubin, Better Than Before: Mastering the Habits of Our Everyday Lives (2015)

According to her Four Tendencies framework, people generally fall into one of four groups. The key to these characterizations is how we respond to expectations. Per Rubin, a brief description of each:

  • Upholders want to know what should be done.
  • Questioners want justifications.
  • Obligers need accountability.
  • Rebels want freedom to do something their own way.

Selected quotes:

Habits are the invisible architecture of daily life. We repeat about 40 percent of our behavior almost daily, so our habits shape our existence, and our future. If we change our habits, we change our lives.

The desire to start something at the “right” time is usually just a justification for delay. In almost every case, the best time to start is now.

The most important step is the first step. All those old sayings are really true. Well begun is half done. Don’t get it perfect, get it going. A journey of a thousand miles begins with a single step. Nothing is more exhausting than the task that’s never started, and strangely, starting is often far harder than continuing.

V. Charles Duhigg, The Power of Habit: Why We Do What We Do in Life and Business (2012)

According to Duhigg, any “habit loop” consists of a cue, a routine, and a reward. Taking alcoholism as an example of a habit/addiction, he states that groups like AA (or NA or GA, and so on) often provide a way to form new but similar habit loops.

Duhigg’s ideas about keystone habits, or “habits we develop that lead us to make better choices in other parts of our life,” are particularly important. David Allen, author of Getting Things Done, states, “His chapter on ‘keystone habits’ alone would justify the book.”

May 02

Depression Memoirs and Research

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The following books about depression are recommended. All are memoirs, at least in part.

I. Alex Riley, A Cure for Darkness: The Story of Depression and How We Treat It (2021)

A psychiatrist reviewing A Cure for Darkness on Goodreads concludes: “What Riley successfully demonstrates throughout this book is that depression is an incredibly complex and diverse clinical condition. He shows how our understanding of the biological, psychological and sociocultural mechanisms underpinning depression has improved, alongside the sometimes empirical, sometimes scientific treatments. By doing so, he sheds light on the reasons why successful treatment of depression can be such a huge challenge for clinicians and patients alike.”

II. John Moe, The Hilarious World of Depression (2020)

Public radio personality John Moe, who has a podcast called The Hilarious World of Depression, is a funny person; he’s also been depressed most of his life.

Moe likes being able to put mental health issues out in the open, easing stigma for “saddies” while also educating the “normies.”

III. Lauren Slater, Blue Dreams: The Science and the Story of the Drugs that Changed Our Minds (2018)

Psychotherapist and writer Lauren Slater knows all too well the benefits and disadvantages of taking psychotropic drugs. Diagnosed with depression and bipolar disorder, she’s not only been on Prozac (she authored the bestselling Prozac Diary in 1998) but also various other medications over the years. She believes there are physiological tradeoffs to taking these.

What may bring hope in the future, she notes, are the psychedelics, such as LSD, MDMA, and “magic mushrooms.” In addition, there will be “neural implants that provide a ‘malleable and reversible form of psychosurgery’” (Publishers Weekly).

IV. Johann Hari, Lost Connections: Why You’re Depressed and How to Find Hope (2018)

Journalist Hari tells readers his own long-term depression has been blamed on a chemical imbalance in the brain. However, at some point in his therapeutic process “…he began to investigate whether this was true – and he learned that almost everything we have been told about depression and anxiety is wrong.”

Hari’s research led him to this basic conclusion (HuffPost): “I learned that there are in fact nine major causes of depression and anxiety that are unfolding all around us. Two are biological, and seven are out in here in the world, rather than sealed away inside our skulls in the way my doctor told me…I was even more startled to discover this isn’t some fringe position – the World Health Organization has been warning for years that we need to start dealing with the deeper causes of depression in this way.”

V. Natasha Tracy, Lost Marbles: Insights into My Life with Depression & Bipolar (2016)

This is a collection of articles Tracy has written and previously posted at Bipolar Burble and Breaking Bipolar.

In an interview conducted by Leslie Lindsay Tracy states, “I don’t believe in the concept of ‘stigma’ per se. What I believe in fighting is prejudice and the inevitable discrimination that follows it. I believe that by making people with mental illness three-dimensional people with real emotions and real struggles, we actually start to sound just like everyone else – just amplified.”

VI. David Blistein, David’s Inferno: My Journey Through the Dark Wood of Depression (2013)

Blistein’s reference point is The Divine Comedy of the poet Danté, who was familiar with “both depths of despair and manic visions of rapture.”

Caroline Carr, author of Living with Depression: How to Cope When Your Partner is Depressed, calls David’s Inferno “(w)arm and compassionate, often hilarious, and full of hope and encouragement.”

VII. Andrew Solomon, The Noonday Demon: An Atlas of Depression (2001)

For a deeper look at this groundbreaking memoir, see my previous post.

Apr 26

How to Listen Better: Experts, Opinions, and Quotes

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Below is advice from two contemporary books that tout learning how to listen better, plus info about the use of active listening and some humorous quotes.

I. You’re Not Listening: What You’re Missing and Why It Matters (2020) by Kate Murphy

One major reason we should listen to each other is that it connects us more closely with others, a phenomenon sorely lacking in society these days.

So, then, how do we learn to listen better? It is, after all, an acquired skill. Kirkus Reviews:

During a conversation, ‘you make yourself aware of and acknowledge distractions, then return to focus…She points out that one of the primary obstacles to listening is the assumption that we know what someone is going to say, which means, unfortunately, that we’re least likely to pay attention to the people closest to us, including spouses, children, and friends.

From an interview with the author on her Amazon page, here’s some helpful advice about curbing this tendency toward half-hearted listening:

A better response will come to you when you have taken in all that the other person has to say. Then, pause if you need to after the other person concludes to think about what you want to say. And if you’re still at a loss, it’s okay to say, ‘I don’t know what to say.’ You can also say, ‘I’d like to think about that,’ which conveys that you’re honoring what the other person said by taking time to think about it, while, at the same time, honoring that part of you that is uncertain or anxious and needs time to process. Better that, than responding in a way that is insensitive or misses the point.

II. Becoming Wise: An Inquiry into the Mystery and Art of Living (2016) by Krista Tippett

One key way to get wisdom? As stated to Paul Brandeis Raushenbush, Huffington Post: “Start with the attention you give to the words you speak…A corollary is (that) we become wise by asking better questions and being listeners, as well as speakers. As I say, generous listening is not about being quiet, it’s about being present. So there’s something about wisdom that knows the power of words and also knows the power of presence and of knowing when to speak is not the right thing.”

III. Active Listening

Neuroscientist Robert K. Cooper,, co-author of Executive E.Q.: “Many ‘active listening’ seminars are, in actuality, little more than a shallow theatrical exercise in appearing like you’re paying attention to another person. The requirements: Lean forward, make eye contact, nod, grunt, or murmur to demonstrate you’re awake and paying attention, and paraphrase something back every 30 seconds or so. As one executive I know wryly observed, many inhabitants of the local zoo could be trained to go through these motions, minus the paraphrasing.”

John Gottman, a marriage researcher, similarly pooh-poohs active listening. Although he once thought it worked, he eventually concluded his clients weren’t really helped by it.

In an interview with Randall C. Wyatt on psychotherapy.net, Gottman explained that the concept works better in therapeutic dialogue than in real-life dialogue. The difference? In therapy “…the client is paying, the therapist isn’t paying. Usually the client is complaining about somebody else, so it’s very easy for the therapist to say: ‘Oh, that’s terrible what you have to put up with, your mother is awful, or your husband, or whatever it is. I really understand how you feel.'”

IV . Humorous Quotes About Listening 

Fran Lebowitz, humorist: “The opposite of talking isn’t listening. The opposite of talking is waiting.”

Mark Twain, writer: “Most conversations are monologues in the presence of witnesses.”

Robert McCloskey, author: “I know that you believe you understand what you think I said, but I’m not sure you realize that what you heard is not what I meant.”