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An interesting photo gallery here, where therapists muse on their offices. More than just decorating tips, they explore the thought process that went into creating a therapeutic space.  Author Jose Ribas MD explains:

An examination room in a North Carolina hospital or clinic probably appears quite similar to an examination room in a hospital or clinic in New York, South Dakota or Texas. Where this model departs is in Psychiatry, where the room itself plays an important role, as it becomes the physical “holding environment” where the therapist conveys to the patient that he or she is safe to explore those areas within him/herself that are threatening or causing distress.

My Tuesday-Friday office. The architects added on to the building some years ago, giving my clients and I a view of the billing area. (photo credit: Mrs. ‘Sphere)

Designing my own space, the aim was to balance professionalism and homeyness; to be colorful but not gaudy and warm without being oppressive. I realize now that all three posters show scenes from Europe. We Americans associate the continent with intelligentsia – perhaps it’s saying, “I’m smart enough to help you solve your problem.”

@ 2012 Jonathan Miller All Rights Reserved

“He struggled against an upsurging hilarity — that any reputable medical man should have lent himself to such an amateurish experiment! “— Señor, I must tell you that in these cases we can promise nothing.”

- F. Scott Fitzgerald, Tender is the Night

When a study is retracted, it usually gets a fraction of the attention it received when published. (just ask the parents who refuse to believe there is no connection between autism and vaccination.) This deserves to be bigger news than it has been:

In 2001 U.S psychiatrist Robert Spitzer conducted a study that claimed gay men and women could be turned straight through psychotherapy.

He has now retracted the highly controversial view.

Spitzer’s 2001 study earned extra attention because he led the charge to have homosexuality removed from the DSM in 1973 .  Back then, the reasoning was simple: homosexuality couldn’t be a disturbance in one’s psychological well-being.  Homosexuals and heterosexuals both scored in the normal range on tests of psychological well-being. When Spitzer suggested that orientation might be changeable, pseudo-scientific organizations such as NARTH seized on it as evidence that homosexuality was curable.

“Conversion therapy” goes back to Freud’s time, but it was largely abandoned when the DSM dropped same-sex attraction as a mental health issue.  Conversion therapists’ success stories include gay people who stay celibate, and bisexual people who limit themselves to opposite-sex relationships.  None established a consistent track record of helping those exclusively attracted to the same sex become exclusively attracted to  the opposite sex – that is, “converting” them. The American Psychiatric Association condemned conversion therapy in 1998 and again in 2000; they found the anecdotal evidence of success was outweighed by considerable anecdotal evidence of emotional harm.

“Homosexuality is assuredly no advantage, but it is nothing to be ashamed of, no vice, no degradation; it cannot be classified as an illness,” – Sigmund Freud, 1935

When one former conversion-therapy advocate estimates the failure rate at 99.9% and another states, “Actually I’ve never met a man who experienced a change from homosexual to heterosexual,” it’s safe to say conversion therapy is a sham. Spitzer’s retraction removes one of the last shadows of doubt from the question.

Shout this one from the rooftops: you can’t cure what isn’t a disease. Sexual orientation is fundamental.

@ 2012 Jonathan Miller All Rights Reserved

Much respect to you both, but there’s still no caloric cure for emotional ills.

… At least, I don’t think so. May need to do a few pints’ worth of research.

@ 2012 Jonathan Miller All Rights Reserved

After just a few quick hours of procrastination, I start looking for materials for a new post. The first promising topic I find is a new intervention that helps short-term disability recipients get back to work. Coincidence? I’ll tell myself that it is.

Suzanne Lagerveld, Roland W. B. Blonk, et al, of Utrecht University dub their cognitive-behavioral therapy (CBT)-based intervention, “W-CBT”.  Besides treating mental health symptoms generally, it provides a module that focuses on work-related cognitions and returning to work in gradual steps. For their research just published in the Journal of Occupational Health Psychology, the authors enlisted employees on short-term disability for mild anxiety and depressive issues. They ruled out those with major depression, post-traumatic stress disorder or physical disabilities. One half of their sample received the new modality and regular CBT was provided to the rest. Per their findings, (PDF here, at least for now), W-CBT got clients back on the job significantly faster. After three months, 15% more W-CBT clients were back to work than clients from the standard CBT group. After six months, that gap increased to 18%. As the authors point out, mental-health absenteeism means lost productivity and profits.  The study’s faster return-to-work (RTW) rate provided a euros-and-cents benefit to Dutch employers, the Netherlands’ economy and society as a whole.

So why doesn’t it feel right?

What if he doesn't want to focus on returning to work ASAP?

Part of informed consent is the client’s freedom in choices about their therapy, including their choice of goals. The article doesn’t address who the client is in W-CBT. Is it the employer, who pays part of the insurance cost?  Or is the employee, who might not want to prioritize RTW? You could argue employees are morally obligated get back to work as fast as possible – if you were their clergyperson. Psychotherapists have a duty not to impose their views on clients, even such widely-held values as a work ethic.

The article states clients were not required to address RTW issues, but that the therapists were encouraged to say things such as, “You won’t recover from your symptoms just by sitting at home. It would probably even get worse.” Per this study, that isn’t necessarily true. According to Lagerveld and Blonk’s  findings, W-CBT and regular CBT had about the same effect on mental health symptoms. If it was once OK to imply symptoms grow worse if one doesn’t race back to the job site, it doesn’t appear ethical anymore.

The researchers are to be congratulated on producing a fascinating conundrum – W-CBT may be simultaneously effective, good, and, at least in some situations, ethically wrong.

Citation:

Work-focused treatment of common mental disorders and return to work: A comparative outcome study. Lagerveld SE, Blonk RW, Brenninkmeijer V, Meij LW, Schaufeli WB. J Occup Health Psychol. 2012 Feb 6.

@ 2012 Jonathan Miller All Rights Reserved

From the great historian’s account of the Battle of Marathon:

A strange prodigy likewise happened at this fight. Epizelus, the son of Cuphagoras, an Athenian, was in the thick of the fray, and behaving himself as a brave man should, when suddenly he was stricken with blindness, without blow of sword or dart; and this blindness continued thenceforth during the whole of his after life. The following is the account which he himself, as I have heard, gave of the matter: he said that a gigantic warrior, with a huge beard, which shaded all his shield, stood over against him; but the ghostly semblance passed him by, and slew the man at his side. Such, as I understand, was the tale which Epizelus told.

@2012 Jonathan Miller, all rights reserved