Is Talk Therapy Effective for Depression?

This article has stirred up a lot of media interest, likely because it appeared in the august New York Times instead of a smaller venue. Its thrust is that a great number of studies measuring the effectiveness of talk therapy for depression never get published, leading publications to a biased sample that inflects toward successful outcomes. It’s not clear from the article whether the balance of studies were sufficiently negative to impact the “correct” success rate for talk therapy in depression, or even why many of the studies’ authors chose not to pursue publication. For instance, it is possible that poor design and execution left some of the unpublished papers lacking.

What cannot be denied is that this particular proportion of publication is hardly unique to this area of psychology:

Disappointing as those responses may be, they’re part of a larger systemic problem within many fields of science — a so-called “publication bias” where researchers feel compelled, often inadvertently, to only publish flashy, positive studies and shelve away less impressive findings. It’s a bias that can have some serious repercussions in the scientific world. "It's like flipping a bunch of coins and only keeping the ones that come up heads," Hollon said.

Until we can analyze everything that’s missing, it makes sense to bemoan the lack of completist tendencies in scientific circles. But to declare talk therapy ineffective for depression seems a bridge too far, as numerous other publications and individuals have found.

If you’d like to speak with a depression therapy expert in New York today, please contact PPSC.

A Poignant Piece About the Special Space of Psychoanalytic Therapy

A number of psychoanalytic therapists have been passing around this beautifully written piece from the New York Times. In it, the writer describes the strong and respectful relationship she always shared with the therapists who occupied the office next to her own. It is an unusual relationship: these are figures she sees several times a week, but they are people with whom she maintains a respectful distance, as accorded by the psychoanalytic endeavor and its emphasis on discretion. When one of those doctors grew slowly sick and eventually succumbed to illness, she was moved more than she ever would have thought possible:

Why am I sharing this small story? Perhaps because I love that psychoanalysis is a frame through which I have permission to pay close attention to peripheral vision, to things that are out of focus and not so conscious. Enigmatic dreams, childhood memories and mourning are all welcome, and they open me to my own feelings and to a wider range of human experiences.

Psychoanalytic therapy is about a great many things: communication, trust, exploration and facing that which is hard. It’s also about the small interactions that surround the therapeutic space, and how they cultivate a climate of emotional mindfulness.

At PPSC, we believe that psychotherapy can serve people’s health in uncountable ways, helping to ease depression, anxiety and a number of related maladies of the soul. If you’re interested in exploring what analytic therapy can do to improve your life, please contact us today.

Wrestling with Fertility in Analytic Therapy

We have written before about what happens when the veil of privacy lifts between a psychoanalyst and her patient, and about how such personal disclosures (by the therapist) can change the tenor of “the room.” This recent piece explores one of the most common issues that prompts therapists into candid conversations : pregnancy. As the author describes:

Traditional psychoanalytic theories envision the therapist as a blank slate on which patients project their thoughts and fantasies, a distant expert interpreting the patient from behind an inscrutable facade. Patient’s concerns are seen as problems the doctor can “fix” through psychological suturing. Contemporary psychoanalytic viewpoints, by contrast, have given rise to a very different understanding of the therapeutic alliance, one in which the relationship itself is ultimately what’s curative. But the therapist’s quasi-anonymity remains a central tenet. Patients might inquire about a therapist’s personal life, but unless it benefits the patient’s growth to answer the question directly, the therapist usually explores what the question means to the patient.

In practice, such questions become harder to avoid when a visible pregnancy enters the therapeutic space. The author of this piece wrestled with a number of approaches to manage and explore the feelings her growing belly inspired, but the responses for her and patients were often more personally charged than other conversations.

After negotiating a heartbreaking miscarriage and another pregnancy, the author describes how she has come to a sense of accommodation about discussing some personal issues surrounding pregnancy and childbirth with her patients, and how the work is often more beneficial for it:

There was a time when I would have reflexively asked Maya what my maternity might mean to her. But instead I considered revealing a small but profound piece of my life. What I hope to offer my patients now, in both subtle and demonstrative ways — shared and silent — are the arduous lessons learned through personal pain and reflection. Far from a blank slate, but no longer a focal point of the therapeutic relationship, I’ve landed somewhere in between, a much more ideal middle ground.

“Yes,” I began my reply to Maya. “I have two children.”

Psychoanalytic therapy is a deep and lasting process such feelings are worth exploring and where patients can make great strides in a safe space. To speak with an expert psychotherapist in New York today, contact PPSC.

The Power of Psychoanalysis

One of the fascinating things about analytic therapy is that everything goes into the hopper: your life, your feelings, your relationships, your depredations – even your accidents can be grist for therapy. This recent piece in the New York Times highlights a good example of how seemingly random accidents can bring our personal histories to the fore, and help patient and therapist alike discover meaning in something that may have seemed meaningless.

The author’s patient suffered burns over the summer, and the injury and its aftermath underscored some longstanding issues of enmeshment with the patient’s mother. On the subject of her mother’s prurient interest in the extent of these injuries, for instance, the patient reports:

“And my mother replied: ‘It’s my trauma, too. In fact, I think I’m more traumatized by it than you.’”

Sometimes the things we say illuminate far more than we intend, and psychoanalysis is a perfect forum to explore these valences. The mother’s words in this case provide a nice starting to explore what has gone wrong between these two women.

Psychoanalytic psychotherapy is the only existing modality that lets us understand our lives and histories from an emotional perspective. As the writer says:

One of the things I miss most about my own analysis is the suddenness with which strange events could emerge, knocking you over backward. And toward the very end it felt as if you could time-travel, bouncing between a past and present whose surface was fabricated by an ancient mythology, the wondrous accident that was your existence.

If you’d like to explore the fundamental psychology that continues to influence your life and choices, please contact PPSC to find a therapist today.

Navigating Transference in Psychotherapy

Most of us who work in psychoanalytic psychotherapy owe a debt to Sigmund Freud, whose first steps defining the field shone a great light on the role of our unconscious minds. Freud’s body of work is not without its flaws, but his insights across a broad diversity of subjects have more or less stood the test of time. One of the issues Freud took particular interest in was the dynamic of the therapist’s office. Analytic therapists are generally discouraged from revealing too much about their personal lives, for fear of staining the therapeutic process with unwelcome details. As a recent New York Times piece described it:

In psychoanalysis, there is a specific rationale for this rule. The theory holds that patients tend to re-enact with therapists the relationships they had with their parents. This is called transference. By paying careful attention to this unfolding drama — as it plays out, right there in the office — the therapist and patient can uncover and resolve childhood conflicts. If a therapist interjects information about herself, she clouds the mirror and compromises the process.

Follow this story to its conclusion, however, and you can see how the benign neutrality of the therapist might come to be seen as a hindrance in some cases, even an act of hostility. In the case study within the piece, a patient desperately needs a sense of reciprocity, even a shallow one, in order to build the trust necessary to do the work:

As therapy continued with her, I heard how flat and tinny I sounded whenever I attempted to analyze what was going on between us. When I lapsed into too clinical a mode, our connection would wobble, and her alienation became palpable.

No two talk therapies are the same, and of course every psychoanalyst develops her own approach and rhythms. Learning and adapting is part of what makes an effective therapy worthwhile, for patient and therapist alike. If you’d like to embark on a journey to address longstanding feeling of depression, anxiety or loneliness, please contact the expert NYC therapists of PPSC today.

Shining Light on Suicide

Suicide is the single most anguished gesture a person can make. Friends and family left behind often find themselves struggling to make sense of the act – was it a cry of shame, or pain, or fear, or perhaps just a function of emotional exhaustion? Specialists in psychology know that suicide is intimately associated with depression, which is one reason so many careful questions are asked whenever depression warrants hospitalization. Yet these efforts have generally failed to reduce the overall rate of suicide in America, which has risen sharply over the last two decades. Now a new population of people is speaking up for their chance to help: those who have tried, and failed, to take their own life:

Plans for speakers bureaus of survivors willing to tell their stories are well underway, as is research to measure the effect of such testimony on audiences. For decades, mental health organizations have featured speakers with schizophrenia, bipolar disorder and depression. But until now, suicide has been virtually taboo, because of not only shame and stigma, but also fears that talking about the act could give others ideas about how to do it.

There is no doubt that fellowship and community have been established to provide comfort to many people with mental health issues. Although such fellowships are only moderately successful with compulsive acts like addiction, they may prove more successful for disorders like depression, which are often marked by a pervasive sense of isolation.

If you are someone you know is struggling with feelings of despair, PPSC offers depression therapy that may help to lift the heavy burden of chronic emotional pain. Call us today to learn more.

Is Sluggish Cognitive Tempo a Thing?

The DSM remains a source of perpetual controversy, not just within the field of psychiatry, but within the press and public as well. It isn’t hard to see why. With its dogmatic tone and Orwellian self-certitude, this foundational document bears all the hallmarks of a holy text rendered into the scientific milieu. But the DSM is also unfairly maligned at times. As a touchstone for useful analytic therapy and psychiatric care, the manual has undoubtedly helped millions of people discover and name what ails them. The DSM has also been a tool of political progress over time, not least in its evolution over LGBT identity and recognition.

But now a new diagnosis is banging at the gates. A number of doctors are telling the public that we must accept a brand new attention disorder: Sluggish Cognitive Tempo, or SCT. Never mind that the name seems ripe for revision in the very near future (sluggish?), the diagnosis itself remains frustratingly vague. It describes, in the broadest sense, those who “tune out” or daydream, causing them to lose focus without any hyperactivity.

Some people are unhappy with this idea, and many of them have a pretty good argument that this latest malady may be little more than a rearguard effort by pharmaceutical companies to sell us more pills. Attentional deficit disorders as a group are already somewhat controversial, as few prescribing doctors ever bother to discuss subtler behavioral solutions such as improving sleep patterns before they reach for the pad. (We have learned the lesson many times before that prevention is always safer than prescription; consider this example from the world of orthopedic medicine.)

And there is this:

Yet some experts, including Dr. McBurnett and some members of the journal’s editorial board, say that there is no consensus on the new disorder’s specific symptoms, let alone scientific validity. They warn that the concept’s promotion without vastly more scientific rigor could expose children to unwarranted diagnoses and prescription medications — problems that A.D.H.D. already faces.

Daydreaming is simply what we do in childhood, and it’s unclear whether some people do so much of it that it should be pathologized. Until we know, it is probably best to let nature run its course, engage in talk therapy wherever it may help, and medicate only as a last resort.