Oct 04

“A Cure for Darkness” by Alex Riley

“Depression is something that I’m very familiar with, but the book isn’t just about me; it is not a memoir,” states science writer Alex Riley about A Cure for Darkness: The Story of Depression and How We Treat It. “It is a history of depression from around the world, how it manifests itself in different cultures and, most importantly, how we treat it. An estimated 315 million people live with depression and it is set to become the leading cause of disability bar none” (Alexriley.co.uk).

From the publisher, a little more introduction of Riley’s new book:

Since 2015, Riley has received both cognitive behavioral therapy and antidepressants for his own depression. Throughout his treatment, he wondered—are antidepressants effective? Do short-term talking therapies actually work? And what treatments are on the horizon for those who don’t respond to these first-line treatments? Expanding from his own experience, he tracks treatments through history, from the ‘talking cure’ to electroconvulsive therapy to magic mushrooms.

A psychiatrist reviewing A Cure for Darkness on Goodreads notes that Riley first covers pre-1900’s history, which of course includes much about Freud, then 20th-century advances in both biological and talking therapies, and finally what’s happening today as well as what’s in our future. “For example, here, Riley talks about the insights from recent neuroimaging studies and the little-understood links between depression, inflammation and diet, as well as the use of deep brain stimulation (DBS) and psychedelic drugs in the treatment of the condition.”

A critique excerpt from Kirkus Reviews:

Treatments would rise and fall—e.g., various forms of lobotomies—and some would rise again (electroshock therapy). Riley discusses numerous studies and anecdotes to illustrate the positives and negatives of each approach to treatment, including modern-day investigations into cognitive behavioral therapy, psychoactive drugs (ayahuasca, LSD, etc.), and deep brain stimulation, often employed for patients whose ‘depression seemed intractable. A diversity of drugs—antidepressants, antipsychotics, tranquilizers, mood stabilizers—couldn’t budge their mental anguish.’

Although very favorably reviewed by many experts, some early lay readers have found A Cure for Darkness to be more textbook-like than they’d have preferred, particularly noting that this is not a self-help book.

Sep 08

Therapist Self-Disclosure: Appropriate, Powerful Uses

Several therapists have written and spoken publicly about the topic of therapist self-disclosure.

One prominent psychologist who’s done so is David Treadway, whose late-stage cancer became the subject of a memoir, Home Before Dark: A Family Portrait of Cancer and Healing (2009). It includes contributions from his wife Kate and his two young adult sons, Michael and Sam.

Treadway’s previous Dead Reckoning: A Therapist Confronts His Own Grief (1996) was similarly self-disclosing about the effects of his mother’s suicide. It included (Publishers Weekly) “parallels between what Treadway’s patients are experiencing and his own problems; revelations of his own therapy; excerpts from his family’s painful recollections; and incidents from his own ongoing life.”

Whether as a therapist or in his writing, Treadway views such openness as a carefully chosen act that can be helpful to others if used appropriately. In Andrea Bloomgarden and Rosemary B. Menutti‘s 2009 Psychotherapist Revealed: Therapists Speak About Self-Disclosure in Psychotherapy, you can find his chapter on what he calls “clinically constructive self-disclosure.”

Another psychologist, Ofer Zur, has said that “(T)he decision to self-disclose is based first and foremost on the welfare of the client.” He acknowledges four types of therapist self-disclosure (“Self-Disclosure and Transparency in Psychotherapy and Counseling“):

  1. Deliberate–such as having a family photo on display in the office or responding  with personal reactions to clients’ statements
  2. Unavoidable–when things about the therapist are observable, e.g., approximate age, ethnicity, gender
  3. Accidental–for example, a client and therapist run into each other at a community event
  4. Clients’ Deliberate Actions–when questions are asked or when info is tracked down, e.g., on the internet (very common these days)

The thoughtful therapist is aware of different ways in which personal info might be revealed and works on ways not to have self-disclosure interfere with a client’s work. Above all else, it should not be about the shrink trying to get his/her own needs met.

Possibly the only shrinks today who don’t sometimes use self-disclosure or at least deal with it to any significant degree are the traditional analysts, those who may still subscribe to the “Don’t just say something, sit there” strategy and who believe in a strict interpretation of the “blank screen” approach, i.e., “only if I am inscrutable to you can you do the important work of projecting your childhood stuff onto me.”

Psychoanalyst Linda B. Sherby addressed this in the process of writing Love and Loss in Life and in Treatment (2013), which is about the grief process related to the death of her husband George. Although she anticipated condemnation from other analysts regarding her self-disclosure she felt “it was important…to demonstrate how a therapist’s present life circumstances affects the therapeutic relationship because I do believe that particular aspect of the patient/therapist interaction has been largely ignored.”

States Janine Roberts, Ed.D., an author and scholar who’s studied therapist self-disclosure (Psychotherapy Networker):

Hundreds of therapists in workshops I’ve led in the United States, Europe, and Latin America have said they share personal information to strengthen the therapeutic alliance, demystify therapy, and reduce the power differential between themselves and their clients. Given that research has found that the quality and nature of the therapeutic relationship–not the specific model or method–account for up to 30 percent of the variability in therapy outcomes, they’d appear to be on to something.

Furthermore, Roberts cites research indicating “that clients working with therapists who don’t self-disclose often describe the experience as problematic.”

Increasingly, I think that clients expect or want from their shrinks more personhood and less unknowability. Very often they’re working themselves to be more open and better understood—so isn’t it useful for therapists to model this in appropriate ways?

Aug 18

“I Hate You…”: And Other Books for Understanding BPD

Starting with the classic I Hate You–Don’t Leave Me, the following are three of the most widely read and recommended books for those wishing to have a better understanding of Borderline Personality Disorder (BPD).

I.  I Hate You–Don’t Leave Me: Understanding the Borderline Personality by Jerold J. Kreisman, MD, and Hal Straus (updated in 2010)  

Around a long time, this book’s most recent update, according to the publisher, “…now reflects the most up- to-date research that has opened doors to the neurobiological, genetic, and developmental roots of the disorder as well as connections between BPD and substance abuse, sexual abuse, Post-Traumatic Stress Syndrome, ADHD, and eating disorders.”

II. Stop Walking on Eggshells: Taking Your Life Back When Someone You Care About Has Borderline Personality Disorder by Paul T. Mason, MS, and Randi Kreger (updated in 2020)

From the blurb:

Stop Walking on Eggshells has already helped more than a million people with friends and family members suffering from BPD understand this difficult disorder, set boundaries, and help their loved ones stop relying on dangerous BPD behaviors. This fully revised third edition has been updated with the very latest BPD research on comorbidity, extensive new information about narcissistic personality disorder (NPD), the effectiveness of schema therapy, and coping and communication skills you can use to stabilize your relationship with the BPD or NPD sufferer in your life.

Beverly Engel, LMFT, author of The Emotionally Abused Woman and The Emotionally Abusive Relationship: “…It identifies two types of BPD—conventional and unconventional. While conventional BPDs typically exhibit overt behavior such as self-harm and suicidal ideation, unconventional BPDs don’t believe they have any problems. They project their pain onto others and refuse to take responsibility for their harmful actions. As an expert in emotional abuse, I have identified this behavior as emotionally abusive.”

III. The Borderline Personality Disorder Workbook: An Integrative Program to Understand and Manage Your BPD by Daniel J. Fox (2019)

Psychologist Daniel Fox has created a workbook that’s received great reviews from readers.

And, from I Hate You‘s author Jerold Kreisman:

Daniel Fox won’t let you off easy. The Borderline Personality Disorder Workbook is truly a book that expects you to WORK! If you think you might have some symptoms of borderline personality disorder (BPD), and are willing to address these problems, and, most of all, are truly committed to working hard at fixing them, this is the book you need.

Aug 11

Gay Conversion Therapy: Movies and Memoirs

Below are recommended movies and memoirs about being victimized by gay conversion therapy, which is defined in the opening to Netflix’s new documentary Pray Away:

Reparative or ‘conversion’ therapy is the attempt to change a person’s sexual orientation or gender by a religious leader, licensed counselor, or in peer support groups. All major medical and mental health associations have denounced the practice as harmful (emphasis mine).

I. Pray Away (2021)

Richard Roeper, Chicago Sun-Times: “…(T)he main storylines center on four former leaders of the ex-gay movement from a generation ago….skillfully interweaves present-day interviews with archival footage of these prominent figures in the movement — all of whom have renounced their roles and are now living as out gays or bisexuals.”

David Rooney, Hollywood Reporter: “A sobering account of Christian intervention rooted in toxic homophobia.”

Dan Callahan, The Wrap: “…(W)e see footage of many so-called ‘ex-ex-gays’ when they were being tortured by their ministries alongside footage of them looking far happier after they escaped.”

II. The Miseducation of Cameron Post (2018)

Gay conversion therapy at a Christian center is what the title character of The Miseducation of Cameron Post (Chloë Grace Moretz) is subjected to when “caught” being a lesbian teenager in the 1990’s. The Emily Danforth novel on which the film is based came out in 2012.

III. Boy Erased (2018)

Based on Garrard Conley‘s 2016 memoir of the same name, Boy Erased has a similar theme to The Miseducation of Cameron Post. As Peter Debruge (Variety) states:

If ‘Cameron Post’ served as a useful tool for teenagers, ‘Boy Erased’ feels like its greatest value will be to parents, particularly those with LGBT children of their own…So often, parents view this news as a reflection on themselves, searching to understand their own failings, or else looking for a way to repair the problem. For Garrard Conley, sharing his story was the key to repairing things with his parents.

IV. But I’m a Cheerleader (1999)

This is fictional, a satire starring Natasha Lyonne as Megan, a teenage cheerleader who is forced to go to True Directions, a camp that aims, via a form of gay conversion therapy, to deprogram the gay right out of its presumably misguided attendees.

V. Two Additional Memoirs (Not Films)

One of These Things First: A Memoir by Steven Gaines (2016)

Meghan Daum, New York Times, summarizes:

For Steven Gaines, growing up as a ‘homo’ in Brooklyn in the 1950s and ’60s meant being ‘a freak, nature’s mistake,’ so at 15 he tries to kill himself by punching through the windowpane of his grandparents’ bra and girdle store. Threatened with hospitalization in a dumpy state mental facility in Queens, he talks his way into a six-month stay at the famed Payne Whitney clinic, in the ‘Ivy League of psychiatric hospitals,’ where former patients have included Marilyn Monroe, Carson McCullers, Jean Stafford and William Burroughs.

Saving Alex: When I Was Fifteen I Told My Mormon Parents I Was Gay, and That’s When My Nightmare Began by Alex Cooper (2016)

Another 15-year-old, this time female, another wrongheaded attempt by society to fix the gayness. Cooper’s Mormon parents took her to church authorities who placed her in “an unlicensed ‘conversion therapy’ center in the Utah desert” that was mentally and physically abusive.

Kate Kendell, National Center for Lesbian Rights: “Alex’s engrossing and shocking story is the triumph of courage, authenticity and hope over shame, bigotry and ignorance. The nightmare of Alex’s story is a key reason we will soon succeed in ending the cruel and dangerous practice of conversion therapy.”

Jun 02

Personality: Can Adults Change? If So, How?

People often wonder if it’s possible to undergo a personality change. It depends: What kind of change?

  • Your behavior? Yes, we can do that. The more habitual our behavior, though, the harder it will be.
  • Your character? Yes. We can work on a trait such as honesty, for example, and improve on it.
  • Your temperament? Not as likely perhaps, but not impossible.

When biological anthropologist Dr. Helen Fisher recommends (CBS News) five ways we can try changing our personality, she means the first two listed above, our character and/or behavior:

  1. Write out a plan
  2. Find the right environment for achieving one’s goals, e.g., people who are supportive
  3. Keep a journal regarding one’s progress
  4. Tell a friend, as this helps with accountability
  5. Reward ourselves

How commonly do people actually change without these kinds of efforts? Psychologist Christopher Soto, NPR, states that personality traits “can and often do gradually change across the life span.”

What’s more, those changes are usually for the better. Many studies, including some of my own, show that most adults become more agreeable, conscientious and emotionally resilient as they age. But these changes tend to unfold across years or decades, rather than days or weeks. Sudden, dramatic changes in personality are rare.

If it’s not because of concerted efforts, other ways people change, adds Soto, involve adapting to occupational or social role expectations and living life meaningfully and satisfyingly.

What about therapy as a means of changing personality?

From a study reported in 2017 (Research Digest):

A new meta-analysis in Psychological Bulletin has looked at 207 psychotherapy and related studies published between 1959 and 2013, involving over 20,000 participants, with measures of personality taken repeatedly over time. The analysis has found that just a few weeks of therapy is associated with significant and long-lasting changes in clients’ personalities, especially reductions in the trait of Neuroticism and increases in Extraversion.

It’s not, by the way, that the other end of the extraversion spectrum, introversion, is undesirable or maladaptive. See posts “It’s Okay to Be Quiet” and “Introversion: Resources…“.

Does therapy have to be long-term? No.

Roughly four or more weeks of therapy was enough to induce meaningful change. In fact, beyond eight weeks, more therapy was not associated with greater personality change. Therapy-related changes to trait Neuroticism were especially significant – a few weeks of therapy led to about half the amount of increase in emotional stability that you would typically expect to see someone exhibit over an entire lifetime (as a general trend, most of us slowly but surely become more emotionally stable as we get older).

Is it the shorter-term types of therapy that have the most success, then? No again. “[The] extent of observed personality change was about the same for different kinds of therapy, for instance be that CBT or psychodynamic…”

How does personality change affect one’s life? A study by Boyce et al., as reported on Psy Blog, “confirmed that personality was the strongest predictor of satisfaction with life. This is well-established and helps explain why some people have everything and are never satisfied and some people have next-to-nothing and seem quite happy with life. It’s not just what you have that makes you satisfied (or not), it’s how you think about it. And those habits of thought are heavily influenced by personality.”