What Makes It Work


Yet another step back to APA Convention in August 2011. I attended it to learn what makes therapy work, if at all? Psychotherapy didn’t work for me, but it has for others, otherwise it would not be practiced in our modern world. I was lucky to attend a session specifically called “What makes it work?”:

There has always been a question of efficiency of therapy. But for non-psychotic disorders psychotherapy in general is better than medications. Physical exercise is important in building biological resilience. The danger of “medication only” approach was illustrated in the book Anatomy of an Epidemic.

So what makes it work? Alliance in individual therapy, cohesion in group therapy and received empathy (no matter if it is sincere or not). Responsiveness, trust, connection with caring and sophisticated clinically trained person. The care professional is the change mediator, who induces action, the moderator of change.

It was mentioned that one size fits all approach has lethal impact. Instead therapists should adapt and tailor. Collect client’s feedback, set individual goals, collaborate and provide positive regard/support.

It all comes to “the person is more important than the disease”. The need to measure reactance level and treatment adaptation. Unfortunately, today 57% of anxiety, depression and child disorders are treated with medication only, and the progress of that care is not monitored properly. Pharmaceutical companies target physicians directly bypassing psychotherapists. $4.2billion is spent on TV advertisement per year, and $2 billion to physicians. They were wondering shouldn’t there be an ad saying: “Antidepressant is not working? Try psychotherapy!” In other countries, like Norway, you have to fail therapy before you get the meds.

At the end of this session someone from the audience asked if a supportive friend could do as good of a job listening to someone’s problems, empathizing and providing support when needed. One of the presenters responded that there are many effective ways to treat depression and anxiety. Besides psychotherapy, physical exercise is very efficient (and it is the least expensive), volunteering, self-help, mentoring, positive relationships, etc.

The culmination of my quest for truth about psychology was the film “State of mind – Healing trauma”. The film, 52 min, was produced by Djo Tunda Wa Munga and Steven Markovitz, distributed by Icarus films, 32 Court Str, 21st Floor, Brooklyn, NY, 11201. I saw it at the APA convention on Sunday, August 7, 2011.

In this film psychotherapist Albert Pesso is invited to the Democratic Republic of Congo where many people suffer from posttraumatic stress disorder from years of horrendous violence. Pesso trains local healthcare workers in a symbolic interaction, short-term, group-based psychotherapy for trauma. The film captures the sessions in a series of fly-on-the-wall scenes using psychotherapy to talk about loss and finding new memories to overlay the traumatic ones.

The effect of the film on me was so profound that I started taking notes as if my own life depended on it. In the movie a person who experiences heavy post traumatic disorder is in the room with a group of health workers led by the American psychotherapist who is old ( in his 70s) but great. Every session had the following scenario: they acknowledged that something bad happened, but those were the circumstances, which are different from now and different from what it could have been.

In one session a young man, who lost his father while he was a boy, was told to pick a man from the audience, who may be his ideal father. Then the “model father”, who was in reality a stranger, hugged the young man and said the following: “If I were in your past, I would have not died when you were a little boy and I would be there to protect you. If I were ideal father, I could have held you like that forever”.

Another healing session was held for a woman who was sexually abused for many years. There were several random people giving her support and assurance of a different reality. “If we were in your past, you could have looked forward to the future. The ideal, we (strangers) would never do that, we would do what is right and just. Replace your old bad memories with good ones, imagine free and able to work”.

This experience creates new intelligence. I was mesmerized with the power of human support. What humans destroyed humans healed.

In summary: replace despair with hope, materialize vibrant vitality in the place of economic and social failure so that people response to each other as a brother, a mother, etc. Instead of craving for power to destroy, they need to understand their need to belong, be fed, loved and cared for. They all need community and meaning in their life. They need a place to nurture, support and protection.

Love you get is love you give and the other way around.

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