Australasian Psychiatry Feature on Psychotherapy –

Edwin Harari 2104 Ghost Busting: Re-introducing psychotherapy for the psychiatrist

Abstract

Objective: The purpose of this paper is to provide a clinically relevant historical and conceptual overview of psychotherapy as an introduction to a forthcoming series of papers on specific models of psychotherapy. The author offers a selective review of some key ideas in the history and practice of psychotherapy.

Conclusion: The principles of psychotherapy should inform all psychiatric practice, including the doctor– patient relationship, multidisciplinary teams caring for patients with complex or ‘treatment resistant’ problems, and patients who are non-compliant with psychotropic medication.

Keywords: psychotherapy, doctor–patient relationship, treatment resistance, psychotherapy and medication

Australasian Psychiatry 2014, Vol 22(5) 433–436 © The Royal Australian and New Zealand College of Psychiatrists 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav

Australasian Psychiatry – Signposts http://www.apy.sagepub.com DOI: 10.1177/1039856214546673

Ghost Busting: re-introducing psychotherapy for the psychiatrist

Edwin Harari Consultant Psychiatrist, St. Vincent’s Hospital Area Mental Health Service, Fitzroy, VIC, Australia

Psychotherapy (‘healing the mind’) is a particular type of interpersonal influence, wherein one person, acknowledged by society as possessing relevant skills (the psychotherapist) seeks to change the thoughts, feelings, attitudes, behaviours, relationships or personality of a suffering other (the patient):

If one posits that the relation between doctor and patient has been critically wounded, how are we to understand whether, and on what basis, that relationship may be reasserted ? AI Tauber

The pedagogy for engaging hidden values and divided selves is the moral building of the clinician as a full developed human being. A Kleinman

I do not favour the way Descartes ontologically screwed up a reasonable search for mind-brain docking during the past four centuries yielding life-denying monstrosities like radical behaviourism and an emotionless information processing cognitivism… J Panksepp

The possibility of intersubjective knowledge offers a welcome relief from a forced choice between pure subjectivity (Descartes) and true objectivity (Kant). EM Hundert

The outcome of the game is to convert what would otherwise be a nameless trauma into a loss. J Lear

As a general rule throughout Asia, the more patriarchal the society, the more the Buddha looks like a woman: the more egalitarian the society, the more the Buddha looks like a man. L Shlain

Psychotherapists, especially, appreciate [that]… this painful ambivalence is as old as the ice-age, a hallmark of Cro-Magnon man, torn between his craving for consolation and his fear of revenge. J Cawte

Each of the above quotations may serve as a conceptual signpost or creative condensation of the argument each of the authors’ advances in their respective texts which bear on the nature, subject matter and practice of psychotherapy.

Read more here

References
 Tauber AI. Confessions of a medicine man: an essay in popular philosophy. Cambridge, MA: MIT Press, 2002, p.103.
 Kleinman A. The divided self, hidden values and moral sensibility in medicine. Lancet 2011; 377: 804–805.
 Panksepp J. The self and ‘its’ vicissitudes. Critique of commentaries. Neuropsychoanaly-sis 2002; 4: 50.
 Hundert EM. Philosophy, psychiatry and neuroscience. Three approaches to the mind. Oxford: Clarendon Press, 1990, p.297.
 Lear J. Happiness, death and the remainder of life. Cambridge, MA: Harvard University Press, 2000, p.92.
 Shlain L. The alphabet versus the goddess. New York: Penguin, 1998, p.200.
 Cawte J. Aboriginal healing: psychotherapy in ancient society. Aust J Psychother 1988; 7: 14.
 Doidge N. The brain that changes itself. Melbourne: Scribe, 2007, p.216.
 Wolff HH. The therapeutic and developmental functions of psychotherapy. Br J Med Psychol 1971; 44: 117–130.
 Markowitz JC and Milrod BL. The importance of responding to negative affect in psycho-therapies. Am J Psychiatr 2011; 168: 124–128.
 Frank JD and Frank JB. Persuasion and healing: a comparative study of psychotherapy (3rd edition). Baltimore: Johns Hopkins University Press, 1991.
 Kernberg OF. Severe personality disorders: psychotherapeutic strategies. New Haven, CT: Yale University Press, 1984.
 Gabbard G and Kay J. The fate of integrated treatment: whatever happened to the biopsychosocial psychiatrist? Am J Psychiatr 2001; 158: 1956–1963.

Deconstructing schizophrenia among Australia’s First People

In places where an increase in the incidence of schizophrenia has been reported, these can be attributed mainly to substance abuse (eg Drug Induced Psychosis). However, there are additional explanations for psychosis differential diagnoses. The most important of these is stress, and especially complex or traumatic stress – presenting as depressive psychosis in both its unipolar and bipolar forms.

I am amazed by the strength of the human spirit and never give up hope | Healthcare Professionals Network | The Guardian

It’s often quite easy to see why someone might be low in mood, or panicky, or hearing voices telling them they are worthless. Sometimes the reasons are less obvious, and we arrange to meet again once we know the client better…

A typical person might have been bullied, neglected or abused as a child; subjected to domestic violence as an adult; and now be on benefits and struggling to feed and clothe their children.

I am amazed by the strength of the human spirit and never give up hope | Healthcare Professionals Network | The Guardian.

Treating Prolonged Grief Disorder: A Randomized Clinical Trial

At last – evidence that feelings are important as well as thoughts (CBT): “emotional processing of memories of the death is an important component to achieve optimal reductions in PGD severity. Facilitating emotional responses to the death may promote greater changes in appraisals about the loss, which are associated with symptom reduction.”

It’s not hard to understand that many psychotic reactions will require similar processing of unbearable affect

JAMA Network | JAMA Psychiatry | Treating Prolonged Grief Disorder:  A Randomized Clinical Trial.

Trauma-informed judges take gentler approach, administer problem-solving justice to stop cycle of ACEs « ACEs Too High

“It was like flipping a switch.

I suddenly had this trauma-informed lens, as we call it. I see it everywhere,” she says, giving an example of someone in front of her on child abuse charges for whom she might recommend counseling and/or anger management. “I have discovered the reality is that when I start asking a few questions, that parent or partner has experienced ACEs,” [the judge] says.

Trauma-informed judges take gentler approach, administer problem-solving justice to stop cycle of ACEs « ACEs Too High.

Women’s Punk Rock Opened Our Eyes To Child Sexual Abuse In The ’90s, And We Need It Back | Junkee

Women’s Punk Rock Opened Our Eyes To Child Sexual Abuse In The ’90s, And We Need It Back | Junkee.

Childhood maltreatment associated with cerebral grey matter abnormalities: Abuse could lead to permanent brain damage — ScienceDaily

Is this where social policy, social and criminal justice,  and neuro-psychiatry finally meet? And importantly, who is to blame for this continued abuse?

Childhood maltreatment associated with cerebral grey matter abnormalities: Abuse could lead to permanent brain damage — ScienceDaily.

END SECLUSION NOW – End Seclusion Now, in all NZ hospitals

“We are absolutely certain that the inevitable abolition of seclusion is near upon us. Join us so we can once and for all eliminate seclusion… now!”

END SECLUSION NOW – End Seclusion Now, in all NZ hospitals.

We need a similar campaign in Australia and the world over!

Welfare cuts may leave 500,000 young people in need of emergency aid: Department of Social Services – ABC News (Australian Broadcasting Corporation)

This approach (withdraw support so the destitute need to come begging for the basics) seems to be an ideal formula for self-stigmatisation and alientation and the perfect approach storm for the developmental illness – perhaps we need a new term for this effect, perhaps “imperiogenic disorder” would fit…

Welfare cuts may leave 500,000 young people in need of emergency aid: Department of Social Services – ABC News (Australian Broadcasting Corporation).

John Read blogs…

John reflects on the work he has done to advance the idea that for many, trauma is the primary source of their vulnerability to psychosis and linked disorders

20 years on: Finally our myopic brain obsession is on the wane.