More recent articles
Therapy that sticks
Quick-fix psychotherapies have been hailed as the gold standard. But depth therapies can be far more enduring and profound
" ...psychodynamic treatment is evidence-based, works just as well as other forms of evidence-based treatment, and also offers special additional benefits. It’s more effective than other treatments when it comes to personality and relationship issues, and it’s the only one shown to offer enduring results. "
https://aeon.co/essays/why-depth-therapy-is-more-enduring-than-a-quick-fix-of-cbt
The Case for Depth Therapy
The kind of psychotherapy that I am trained in and practice has a long tradition behind it. Psychodynamic psychotherapy is constantly evolving and it's proponents represent a vast and vibrant, diverse field of practitioners, organizations, and educational institutions today.
Psychotherapies of depth, insight, and relationship allow people to address the obvious symptoms that they find disruptive, such as anxiety and depressed mood. But they also go further and deeper, into the thoughts and feelings that underlie these symptoms, to figure out why these symptoms are occurring, where they come from, and what can be done about them.
My clients often discover that their emotions and experiences make sense, and that understanding them more fully through our conversations leads to greater self-esteem, creativity, connection, and fulfillment.
Some discount long-term psychotherapy. They may question it's efficacy, they may even argue that there is no evidence for it. They couldn't be more wrong. PSIAN lays out the evidence.
What to know if you want to use your insurance
If you are considering using your health insurance to pay for your sessions, I offer this advice:
You will want to ask your insurer: what kind of mental (or "behavioral") health benefits do you have? Can you select your own "out-of-network" (i.e. not a contracted in-network provider) psychotherapist?
When they quote your benefits, it usually sounds something like: They reimburse you only for ?? % of what they deem to be a "usual and customary" fee for each session, for ?? sessions a year. "Usual and customary" could be anything, maybe $65-120 per session? It's different depending on whether the therapist is in/out of network, an MFT or LCSW or LPC or psychologist, etc.
Sometimes there will be one set of rules before you meet your deductible and a second for after.
Everything should be spelled out in your contract/plan, but it's always a good idea to call them up and ask them to put in writing exactly whether or not you will be reimbursed for (55-minute [in-person, or online 'telemedicine'] psychotherapy) sessions with your "out-of-network" therapist, and how much, and for how many sessions per year, and whatever other limitations may apply.
Be aware that a lot's been going on recently surrounding the increasing problem of tedious pre-payment reviews, invasive requests of questionable legality given mental health parity and privacy protection laws, and other frustrating delays and denial tactics (see https://www.apaservices.org/practice/legal/managed/optum-pauses-prepayment-review).
Patients' claims are routinely denied. It's difficult and time consuming to get anyone on the phone to explain why. And even when they do, they often contradict information previously or subsequently given.
Hopefully, timely payments will improve, but ask your insurer specifically how long you should expect to have to wait for your claims to be reimbursed. And get that in writing.
The Effect of Infra-Slow Fluctuation Neurofeedback Training on a Cohort of Insomina Participants
I share this fabulous little research article, one of many on the positive effects of ISF neurofeedback, because it describes a very simple yet elegant study. The researchers who composed the study measured several important biomarkers, not just of sleep, but measuring effects on heart rate, muscle tension, blood pressure, and more. Thus, they demonstrated not only that ISF neurofeedback is excellent for insomnia sufferers, but they also clearly showed that ISF tends to have many other healthful effects, not limited to improved blood pressure, heart rate variability, and reduced muscle tension.
You can read the study here: https://www.neuroregulation.org/article/view/21952
Scientists Find No Evidence That Depression Is Caused by “Chemical Imbalance” or Low Serotonin Level
This is really old news, but unfortunately, many people are still unaware.
A few nuggets from the article:
“Our view is that patients should not be told that depression is caused by low serotonin or by a chemical imbalance, and they should not be led to believe that antidepressants work by targeting these unproven abnormalities. We do not understand what antidepressants are doing to the brain exactly, and giving people this sort of misinformation prevents them from making an informed decision about whether to take antidepressants or not.”
Co-author Dr. Mark Horowitz, a training psychiatrist and Clinical Research Fellow in Psychiatry at UCL and NELFT, said: “I had been taught that depression was caused by low serotonin in my psychiatry training and had even taught this to students in my own lectures. Being involved in this research was eye-opening and feels like everything I thought I knew has been flipped upside down.
“One interesting aspect in the studies we examined was how strong an effect adverse life events played in depression, suggesting low mood is a response to people’s lives and cannot be boiled down to a simple chemical equation.”
Professor Moncrieff added: “Thousands of people suffer from side effects of antidepressants, including the severe withdrawal effects that can occur when people try to stop them, yet prescription rates continue to rise. We believe this situation has been driven partly by the false belief that depression is due to a chemical imbalance. It is high time to inform the public that this belief is not grounded in science.”
Huberman Podcast
Huberman on Cannabis and Alcohol
Many of my clients use cannabis and /or alcohol, but have concerns about their use. They are interested in learning more about the actual science on the effects of these substances on the body. However, it can be difficult to find "the straight dope" on these topics, beyond the morass of marketing out there. I often recommend a few episodes of the Huberman Podcast.
Andrew Huberman is a Stanford professor of Neurobiology. In his popular podcast, he takes on a different health topic each time and does a deep dive into all the latest scientific research to explain the facts, what we know now, what science has to say about the topic. And when it comes to cannabis and alcohol in particular, because they are powerful industries--it can be hard to separate good information from marketing. So his summaries of the research are really helpful in that respect.
Research shows that cannabis drives up anxiety in users over time, even when it provides short-term or immediate relief in users, and it significantly increases the risk of developing depression, or even psychosis. Studies also show that cannabis is terrible for the developing brain, preventing the development of executive functioning, i.e. the ability to make plans and execute them over time, and significantly reducing blood flow to the brain in heavy users.
Alcohol causes the brain to atrophy, even in persons who consume what was previously thought of as moderate drinking: as few as 7 alcohol units per week.
You can watch the episodes about alcohol here:
https://www.youtube.com/watch?v=DkS1pkKpILY
Alcohol & Your Health (2 hours)
https://www.youtube.com/watch?v=CJynHWYo7D8
What Alcohol Does to Your Brain (9 minutes)
https://www.youtube.com/watch?v=4xU5yIH_P9I
How alcohol actually increases stress levels rather than relaxing you (7 minutes)
The cannabis episode is nearly three hours long. I recommend just watching the last 30 minutes if you are short on time:
https://www.youtube.com/watch?v=gXvuJu1kt48
The effects of cannabis on the brain & body
Helpful Resources
How to Get Rid of Depression
Stephen Ilardi's Therapeutic Lifestyle Change for Depression (Youtube video) Ilardi defines depression as a chronic inflammatory condition, contextualizes it in human evolution, and summarizes the research on what works to get rid of it.
Healing Shame
Brené Brown on Shame (Youtube video) Brown shares her unique research and wonderful humility to illustrate the universal problem of shame in human psychology and relationships.
How to Work with Difficult Feelings
How to Work with Difficult Feelings
In this blog post, Hillary Jacobs Hendel, psychotherapist and author of "It's not Always Depression", explains the change triangle and how it can help you work with difficult feelings or states and connect to your deeper truth.
Risk Factors for Chronic Illness
Risk Factors for Chronic Illness
How to Work with Difficult Feelings
Gabor Maté's 4 Risk Factors for Chronic Illness This profound talk lays out a deep and truly integrative understanding of human being. Maté describes 4 risk factors for chronic illness born of our adaptive and imperative striving for attachment during childhood. The goal of psychotherapy to help change these deeply wired templates of behavior. The audio is a little poor for the first few minutes--hang in there.
Non-Violent Communication
Risk Factors for Chronic Illness
Non-Violent Communication
Here is a cute WikiHow I found on Non-Violent Communication. NVC is an elegant model for communication that can help you resolve conflicts in any relationship. It takes a little effort to learn but this invaluable tool will serve you all your life!
Meditation Made Easy
Risk Factors for Chronic Illness
Non-Violent Communication
Whenever a client tells me me that they want to make meditation a part of their lives I recommend Yoga Nidra. I've found it's a great place to start because, more than any other type of meditation, people find it easy to do, and so they actually do it! Simply lie down, close your eyes, and listen to a recording. You can find some good ones to try here:
https://www.irest.org/try-irest-now
The Power of Breathing
True Sources of Depression & Anxiety Pt 1
True Sources of Depression & Anxiety Pt 1
Do not underestimate the simple power of breathing correctly! When we breathe by expanding our lower torso, rather than with our chest (as most of us do) we increase blood blood flow to our "second brain", the gut. Proper breathing improves digestion, assimilation, absorption of nutrients, gut motility, prevents compression of spinal vertebrae (i.e back pain), prevents menstrual cramps, improves posture and makes us feel more calm and confident! Especially if you're having IBS or any kind of problem with digestion, this is something you have complete power over and can do immediately to reduce pain and feel better. Read more at Erik Peper's excellent blog, the source of the video links above.
True Sources of Depression & Anxiety Pt 1
True Sources of Depression & Anxiety Pt 1
True Sources of Depression & Anxiety Pt 1
The Real Causes of Depression (article) Like many people, the author, Johann Hari was offered medication (based on the false premise of "chemical imbalance") and little actual treatment for his symptoms of depression. He is enlightened in part through conversations with Dr. Vincent Felitti, who created the famous ACEs study which shows how adverse experiences in childhood dramatically increase the likelihood of mental and physical illness in adulthood." ...if he had just told people what my doctor told me – that their brains were broken, this was why they were so distressed, and the only solution was to be drugged – they may never have been able to understand the deeper causes of their problem, and they would never have been released from them."
True Sources of Depression & Anxiety Pt 2
True Sources of Depression & Anxiety Pt 1
True Sources of Depression & Anxiety Pt 2
Another beautiful article on the true sources of depression and anxiety by Johann Hari. He asks, "when will we learn that our pain makes sense?", defines the social and environmental causes of mental malaise, highlights our gross overuse of chemical interventions, and asks us to be more thoughtful. Of particular note is the distinction made between "chemical imbalance", a concept neuroscientist Marc Lewis finds crude at best for describing actual brain changes associated with depression, and "synaptic pruning" --a neuroplastic process: "Your brain sheds synapses you don’t use, and if you are pushed into a pained response for too long, your brain can shed synapses, making it harder to navigate away from dark thoughts." Neuroplastic changes may have some chemical component, but they require neuroplastic interventions (i.e. learning, psychotherapy, experiences, neurofeedback) o be properly addressed and resolved.