It matters that people have a way to use the latest findings in psychology beyond buying a pill for depression. It matters that people have a way of looking at their lives that lets them ask the big questions and determine how they want to live – and that this is supported by therapists and mental health professionals.

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Psychiatry and clinical psychology have failed. Here's how we do better.

Posted on 22 May | 2 comments
Brain scans aren't as useful as therapy for most patients

This has been a bad week for mental illness.

According to the New York Times, five of the current ten “personality disorders” will not be included in the next publication of the Diagnostic and Statistical Manual of Mental Disorders.  The most controversial to be cut is “Narcissistic Personality Disorder” – the “Malady of Me” disease!

So if you’re suffering from those conditions, don’t worry – in 2013 they’ll cease to exist. 

In the meantime millions of people have been diagnosed with Narcissistic Personality Disorder and the other personality disorders that will soon become extinct. They have been medicated, treated in psychiatric hospitals, received psychotherapy and have permanent records stating their psychiatric diagnosis. They have been stigmatized, charged money in the form of co-payments and out of pocket medical expenses, and experienced deep personal pain and shame – only to find that their diagnosis was a “pseudo-diagnosis” and no longer exists.

Truly, this is malpractice and professional negligence.  Even worse:  there is no known cause of any of the ten personality disorders, and never has been.  The gurus at the American Psychiatric Association hypothesize that the personality disorders come from a mix of genetic and environmental factors – but it’s hard not to be be incredulous when five of ten personality disorders are vanishing.

It’s not just personality disorders, either:  another New York Times article last week points out that the cost of residential eating disorder programs can run $30,000 dollars a month – with many patients needing three or more months of treatment. The kicker:  most insurance companies will not cover long term treatment because the inadequate empirical evidence of effective treatment remedies is inadequate. 

We don’t know how to fix an eating disorder, but we’re going to charge you $30,000 a month for trying.  We claim to understand personality disorders, but there could be five, or 10, or none:  the evidence is unclear. 

It’s time to call it like it is:  mainstream psychiatry and clinical psychology are failing. 

Current mainstream treatments are not cost effective and are not working in the long-term.  Diagnostic labeling is destructive, inaccurate and clinically cumbersome.

Clinical psychology is at a crossroads. Communities, families, schools and individuals are ailing and undeniably need its presence – but it has to transform into something better than a pseudo-quantitative pretension that psychology must be biological even if we don’t know how. 

Fortunately, there are better modals.  Humanistic psychology, psychodynamically driven, isn’t a quick fix, but it does live up to its promises. 

One such model is the “Client as Self-Healer” model, proposed by Art Bohart and Karen Tallman in their book How Clients Make Therapy Work.  Bohart and Tallman’s approach, rooted in humanistic principles, directly contradicts the medical model of psychotherapy treatment and has been empirically validated through quantitative and qualitative research.

The Client-as-Self-Healer-Model emphasizes a person’s creative self-healing capacities and resources for problem resolution and change in the context of psychotherapy treatment.  We all have the capacity to solve our own psychological problems, and most of the time we do – we are “self-healing.”  When that capacity for self-healing becomes blocked, stuck, or disabled ... then we turn to other people, including psychologists.  The symptoms and problems that people bring to the therapist’s office are the result of this blockage. 

Fromrom this perspective, therefore the work of therapy focuses in on a client’s abilities instead of disabling “diagnosable pathologies.” Ultimately, therapy becomes an environment where the client becomes energized and stimulated; thus engaging in a powerful personal meaning-making process.

The ultimate diagnostic criteria for Bohart and Tallman,then, is the client themselves.  That’s not something you can quantify in a Diagnostic and Statistical Manual, but it makes sense and it works. 

Based on the diagnostic failures and lack of scientific empiricism in psychiatric medication, psychology would do well to undergo a paradigm shift toward the humanistic perspective embodied in the Client-as-Self-Healer. The credibility of current psychological and psychiatric practice is diminishing and the public’s faith in both institutions is vacillating. Spring has come and the field is ripe for a humanistic revolution towards a strength-oriented perspective embodying the client as the ultimate source of healing.

-- Liz Schreiber

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Comments and Discussions

It has always only been and

It has always only been and always will be only the individual who can do the healing because the healing requires a shift that occurs within the individual.

A therapist can be a catalyst by helping the client believe in their ability to be different, to be more than they are being, but the therapist cannot make the person see their own ability to shift. The therapist, however, can see the client as they could be and through seeing them that way can influence the cleints belief in their own ability to be more.

I like that the discontinuance of the diagnosis of “Narcissistic Personality Disorder” shines a light on how little they have really known about how to help individuals.

I like, even more, that the specific disorder of “Narcissistic Personality Disorder” is being discontinued. A self-focus has long had a bad name when the truth is that we have to put our own oxygen mask on first, before we can be of benefit to others. The Positive Psychology science is finally shinning a light on this by showing that we are more intelligent, more creative, more resilient, more emotionally intelligent, healthier and live longer and, best of all, have better relationships when we are happy. How do we become happy? By focusing on how we feel and using that information in our decision-making processes. They are still not 'spot on' in all areas. They still say things such as "if you are troubled do something for someone else and you will feel better" and while this is often true they do not see the root of why you feel better under such circumstance which is that you feel better because you have removed your focus from your troubles and put your focus onto another area that feels better than your troubles to you. However, they miss the point that it is not necessary to put the focus outside ourselves in order to feel good. There is not any life that does not have something positive on which to focus but most choose to focus on the 'problem areas' which makes them seem larger than they are.

I am not saying it is not good to help others. (More on this later.) I am saying that it is better to know that it is the change of focus that makes the individual feel better and that the subject of the better-feeling focus does not matter. What if you are somewhere (or in a situation) where you cannot easily help others? Far better to know that you can feel better now by looking for a subject that feels better when you think upon it. If you know it is a better feeling focus you can just focus upon something that feels better - it can be from your past or your future or even something else in your present. Have you ever ruined your enjoyment of a delicious meal by focusing upon something that was upsetting while you ate? Why not just focus upon the delicious food in front of you and tell yourself (about the problem) "I don't have to think about this (or solve this) right now".

The science is showing that when we take care of ourselves first and become happy we then, naturally because we are innately social and loving when we are authentic, we then help others and from that position, of being happy and of being able to see the best of our troubled friends, can inspire them to better feeling thoughts and experiences. Those in business have been shown to be better corporate citizens when they are happy. Personal happiness benefits society in may ways including the happy person is less likely to require resources from the health care profession and is likely to be an uplifting influence on those around them, is likely to make better decisions in all areas of life (lifestyle, business, financial, etc.) and is more likely to maintin positive relationships.

They have done humanity a disservice by casting negative connotations over self-love.

"Ultimately, therapy becomes

"Ultimately, therapy becomes an environment where the client becomes energized and stimulated; thus engaging in a powerful personal meaning-making process.". This sums the blog up well. Thank you.

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