Superhero Photo-therapy?

Eugene at My Modern Met has a post about a 91 year old woman who was depressed until her photographer grandson got her to agree to model for a series of “outrageous” superhero photographs.

Copyright Sacha Goldberger: sachabada.com

You can also check her out on Myspace.

What do you think? Is this the next wave of psychotherapy?

Carl Rogers’ Therapy

Here’s an old but good video of Carl Rogers giving an explanation of his Person Centered Therapeutic approach.

Here is the second part of the video where you can see Rogerian therapy in action:

Notice how Person Centered Therapy is non-directive. This means that the therapist does not provide answers for a client, the therapist helps clients work towards their own answers while being as supportive and reflective as possible.

There are more parts to the video, which can be found on YouTube.

Prevalence of Psychologists in Argentina

A 2008 study found that Argentina has 145 psychologists per 100,000 citizens. That is the highest rate in the world. The Wall Street Journal reports the following numbers (from 2005 – the number of psychologists in Argentina has increased since that time):

“Per Capita: Argentina topped a world ranking of psychologists per capita compiled by the World Health Organization in 2005:

Psychologists per 100,000 inhabitants

Argentina: 121.2
Denmark: 85
Finland: 79
Switzerland: 76
Norway: 68
Germany: 51.5
Canada: 35
Brazil: 31.8
USA: 31.1
Ecuador: 29.1

Also: In 2008, Argentina had 145 psychologists per 100,000 inhabitants; the capital, Buenos Aires, 789, according to a report by Modesto Alonso and Paula Gago. A 2009 national survey conducted by TNS Argentina found that 32% of respondents had at some time made a psychological consultation. That was an increase from 2006, when 26% said they had.”

Does anyone know why Argentina has much higher rates of psychologists than other countries? Buenos Aires particularly has a very high concentration of psychologists. What is further interesting is that many of the psychologists – at least inferred from the article – have a psychodynamic background.

So why does Argentina have a high concentration of psychologists? When looking at the list of countries with rates higher than the United States there are a number of possible explanations. One is that psychology is valued more in those countries than it is in the United States. Maybe the people are more trusting of psychologists and open to psychotherapy. Another possible explanation is that people in those countries are more depressed or anxious or have other psychopathology. They also could have fewer other resources to which they can turn for support (e.g., family or clergy or friends). Another possible answer is that there is something about the countries that make psychologists more prevalent. It could be political (maybe more turmoil or less stable governments), criminal (higher rates of crime), or some other psychosocial factor. It’s possible that higher rates of psychologists is related to prevalence of socialistic philosophy. Maybe psychologists in those countries are paid better than they are in countries with lower numbers per capita of psychologists. There could be any number of reasons why there is a higher prevalence of psychologists in Argentina (and other countries for that matter). Any additional thoughts?

The Death of Psychotherapy

I’m going to preface my post by stating that the following post was written to help me think through the relationship between neuroscience and therapy. As such, it is a philosophical journey through some of my thoughts and is not even necessarily what I really believe because I’m still working on discovering what I believe. Thought processes like this are one way I try to keep some of my beliefs about psychology and neuroscience balanced. If I start leaning too strongly one way, I’ll start looking for things that disconfirm those beliefs and see what I discover. It’s a bit of playing the Devil’s Advocate with myself and a bit of philosophizing. Some of my friends and I used to do things like this in junior high and high school – having philosophical discussions where we discussed things and even tried to argue for things that we didn’t necessarily believe (e.g., classic topics such as supposing that this world and universe really aren’t real but are just reflections of reality. Again, that’s not something I believe but we would speculate). What does this all have to do with psychology and neuroscience?

The brain is what drew me to psychology initially. However, I vowed I would never go into clinical psychology because I didn’t think I would like therapy or dealing with people’s problems. Over time I discovered neuropsychology. Most neuropsychologists are clinical psychologists so in order or me to be a neuropsychologist, I had to be trained as a clinical psychologist. There are many things I enjoy about clinical psychology but therapy is not one of those things. Granted, most neuropsychologists do not actually do therapy, but we have to be trained in it. I enjoy talking with people in sessions but I haven’t been that impressed with therapy as a whole so far. Maybe that’s just because I haven’t exactly found the particular type of therapeutic method that really “clicks” with me. Cognitive-behavioral therapy is fine but so much of actual therapy in practice is just plain common sense. However, not everyone has a lot of common sense so they need some training in it. Part of me recognizes the validity of therapy but another part of me struggles with it. Now on to my main article.

The more I study the brain and the more exposure I have to therapy (giving, not receiving), the more biased towards the brain I become. What I mean is that we continue to discover more about the brain and as we discover more, the more behavior we can explain based on biology or neurophysiology and the less important I think therapy is. I’ve written about this topic in the past but wanted to briefly revisit it. This is somewhat of a second chapter to that post. Before I continue I wanted to expose one of my biases; I believe humans have free will. Even though some of my beliefs about the brain could be seen as mechanistic and deterministic, I do not believe that a strongly-biological foundation for behavior rules out free will. You can still assume biological foundations without assuming determinism. If, for example, you have a monistic set of assumptions that incorporates both mind – “nonmaterial” – and body – “material” – in one. [I have quotes around nonmaterial and material because mind is not necessarily nonmaterial and body is not necessarily material, well at least philosophically speaking]. Monism is a similar idea to a unified field theory (e.g., Grand Unified Theory) or the Theory of Everything for which some theoretical physicists are searching. That’s not what I’m going to write about and if it didn’t make sense, then don’t worry about it (I discussed this topic in a couple different posts: here {I linked to that post previously} and here). To summarize, I view behavior through a strong biological bias but I do not assume determinism.

As I said earlier, the more I learn about the brain and behavior (through research and observation), the more I lean towards neuroscience and away from “traditional psychology.” However, I still appreciate the psychosocial aspects of behavior; the nature versus nurture dispute will never be resolved because both are important. The environment is important  – all external stimuli are important – but the problem with downplaying biology is that it is the medium of behavior. What I mean is, everything we think, sense, perceive, or do is translated and transmitted through the firing of neurons. This means that all abnormal behavior, which is what psychologists often are interested in, originates in a neuron or related cell. Whether or not the cause of that behavior was internal or external is irrelevant. All events and stimuli are translated into patterns of neuronal firings.

This is why I think that understanding the biology of the brain is the best way to understand a person’s behavior. However, because we have an imperfect understanding of the biology of the brain, we have an imperfect understand of the biological foundations of behavior. This means that until we have a perfect understanding, we cannot ignore the psychosocial aspects of behavior; even with a perfect understand we couldn’t either because even if we understand the “translation” process we may not understand the origin of what needs to be translated. This is where traditional talk therapy can be most beneficial. However, I still believe less and less that talk therapy is the best solution for dealing with many psychological issues. Over time as we discover more and more about the brain, therapy will become even less important.

That is a fairly radical position to take as a student of clinical psychology – it’s more in line with psychiatry, or rather, I believe it’s more in line with neuroscience. I’m not saying that therapy is useless, I’m just saying that as we gain a more perfect understanding of the brain and how various chemicals interact in the brain, we will have less need for people to help others by “talking” through their problems. The better we understand the physiology of the brain, the more natural our pharmaceuticals will be. In other words, it will be easier to mimic and create normal brain functioning. Of course, many will ask, “What is normal?” That’s a good question.

Some may argue that with depression, for example, many people will have negative image and self-evaluations, which can lead to depression. That is true but it’s the classic chicken and egg question. Which came first? Did the negative thoughts cause the depression or did the person experiencing negative thoughts have a biological predisposition to those thoughts and depression? In other words, it is possible that biology originally led to the negative thoughts and not vice versa. This is all speculation but I think there is increasing evidence for this view.

The big problem with my point though is that at some point, it does become a deterministic system in that it’s possible that we could medicate away people’s free will. This is an unacceptable outcome. There would be a lot of power with this knowledge and many opportunities for abuse. That’s an ethical discussion for a later time.

To summarize, I think that as we (speaking in the collective) gain a more perfect understanding of the brain (and even individual differences in the brain) we will be better able to eradicate and prevent many or most psychological disorders. We could potentially stop schizophrenia through genetic engineering or other modifications. Again, I’m not addressing whether or not we should but I believe we will have the ability to at some point. This is why, at the moment I lean more towards neuroscience than I do psychotherapy. Of course, tomorrow I could [I won’t] write a post that completely contradicts this one. As I said, this is a process. I think it’s important to argue both sides of the issue.

Generalizing Therapy Treatment

There are a number of different strategies to promote generalization of treatment effects in therapy. One common method is to assign homework. Homework is used both for the client to practice therapy techniques as well as for the therapist to assess compliance with and understanding of treatment. As clients complete homework they learn to apply treatment skills to new situations outside of the therapy room; homework is key to CBT. Another method that can promote generalization is exposure (or desensitization), in vivo or imagined. Exposure techniques, especially when they are in vivo, allow for clients to learn how to apply skills they may have learned cognitively but not behaviorally. In vivo exposure provides a way for people to learn that they will live, they will survive, and be happy during and after the time they are facing feared objects or situations. As with any skill, perfection only comes with practice, so desensitization methods provide those opportunities to practice and learn application in multiple situations.

Cognitive restructuring (and flexibility) allows for generalization of therapeutic techniques. When people successfully learn to rethink their reactions to specific situations and events, they then can learn to apply this new way of thinking to multiple situations. This cognitive flexibility allows clients to adapt, progress, and generalize.