hope – It's Interesting

By Allen Frances, MD

There are 3 consistent research findings that should make a world of difference to therapists and to the people they treat.

1. Psychotherapy works at least as well as drugs for most mild to moderate problems and, all things being equal, should be used first

2. A good relationship is much more important in promoting good outcome than the specific psychotherapy techniques that are used

3. There is a very high placebo response rate for all sorts of milder psychiatric and medical problems

This is partly a “time effect”—people come for help at particularly bad times in their lives and are likely to improve with time even if nothing is done. But placebo response also reflects the magical power of hope and expectation. And the effect is not just psychological—the body often actually responds to placebo just as it would respond to active medication.

These 3 findings add up to one crucial conclusion—the major focus of effective therapy should be to establish a powerfully healing relationship and to inspire hope. Specific techniques help when they enhance the primary focus on the relationship; they hurt when they distract from it.

The paradox is that therapists are increasingly schooled in specific techniques to the detriment of learning how to heal. The reason is clear—it is easy to manualize technique, hard to teach great healing.

I have, therefore, asked a great healer, Fanny Marell, a Swedish social worker and licensed psychotherapist, to share some of her secrets. Ms Marell writes:

Many therapists worry so much about assessing symptoms, performing techniques, and filling out forms that they miss the wonderful vibrancy of a strong therapeutic relationship.

Thinking I can help someone just by asking about concerns, troubles, and symptoms is like thinking that I can drive a car solely by looking in the rearview mirror. Dreams, hopes, and abilities are seen out of the front window of the car and help us together to navigate the road ahead. Where are we going? Which roads will you choose and why? It surely will not be the same roads I would take. We are different—we have to find your own best direction.

If we focus only on troubles and diagnosis, we lose the advantage of capitalizing on the person’s strengths and resources. If I am to help someone overcome symptoms, change behaviors, and climb out of difficult situations, I need to emphasize also all the positives he brings to the situation. Therapy without conversations about strengths and hopes is not real therapy.

And often most important: Does the patient have a sense of humor? Laugh together! Be human. No one wants a perfect therapist. It is neither credible nor human.

Symptom checklists and diagnoses play a role but they do not give me an understanding of how this person/patient understands his world and her troubles.

And don’t drown in manuals, missing the person while applying the technique.

People come to me discouraged and overwhelmed—their hopes and dreams abandoned. Early in our time together, I ask many detailed questions about how they would like life to change. What would you do during the day? Where would you live? What would your relationship to your family be like? What would you do in your spare time? What kind of social circle would you have? By getting detailed descriptions, I get concrete goals (eg, I want to go to school, argue less with my parents, spend more time with friends).

Almost always, working with the family is useful; sometimes it is absolutely necessary. What would be a good life for your child? How would it affect you?

Sometimes our dreams are big, perhaps even too extravagant; sometimes they are small and perhaps too cautious. But dreams always become more realistic and realizable when they are expressed. Sharing a dream and making it a treatment goal helps the person make a bigger investment in the treatment, and to take more responsibility for it. He becomes the driver and the therapist may sit in the back seat.

Because my first conversation is not just about symptoms and troubles, we start off on a basis of realistic hope and avoid a negative spiral dominated only by troubles. Problems have to be faced, but from a position of strength, not despair and helplessness.

Having a rounded view of the person’s problems and strengths enriches the therapeutic contact and creates a strong alliance.

Thanks, Ms Marell, for terrific advice. Some of the best natural therapists I have known have been ruined by psychotherapy training—becoming so preoccupied learning and implementing technique that they lost the healing warmth of their personalities.

Therapy should always be an exciting adventure, an intense meeting of hearts and minds. You can’t learn to be an effective therapist by reading a manual and applying it mechanically.

I would tell therapists I supervised never to apply what we discussed to their next session with the patient, lest they would always be a week behind. Therapy should be informed by technique, but not stultified by it.

See more at: http://www.psychiatrictimes.com/blogs/couch-crisis/magical-healing-power-caring-and-hope-psychotherapy?GUID=C523B8FD-3416-4DAC-8E3C-6E28DE36C515&rememberme=1&ts=16072015#sthash.2AOArvAW.dpuf

by John Haltiwanger

As a musical genre, hip-hop is often denigrated for seemingly condoning misogyny, materialism, violence and crime. But this is an unfair characterization and an overgeneralization.

Yes, there are some rap artists who write songs containing nothing of substance. More often than not, however, hip-hop offers many of us an insightful view into a dark world we’re unfamiliar with: the impoverished inner city.

In this sense, hip-hop has the potential to educate and foster empathy.

To borrow from Jay Z:

I think that hip-hop has done more for racial relations than most cultural icons. Save Martin Luther King, because his dream speech we realized when President Obama got elected.

[Hip-hop] music didn’t only influence kids from urban areas. People listen to this music all around the world, and [they] took to this music.

Once you have people partying, dancing and singing along to the same music, then conversations naturally happen after that.

We all realize that we’re more alike than we’re separate.

Indeed, hip-hop breaches ostensibly impenetrable cultural divides, breeding solidarity among people with disparate backgrounds.

This is precisely why recent albums like Kendrick Lamar’s To Pimp a Butterfly have been widely celebrated and even used by high school teachers to teach lessons about race and oppression.

Beyond enlightening people on race, poverty, the War on Drugs and the inner city, it also appears hip-hop has a hidden benefit as a powerful tool against mental illness.

A study from Cambridge University found that hip-hop is extremely effective in combatting depression, bipolar disorder and addiction.

When you think about the themes hip-hop encompasses, this makes a lot of sense. Many artists rap about overcoming numerous obstacles in the ghetto, from gang violence and poverty to drugs and police brutality.

The overall narrative of hip-hop is one of progress. Artists tell dynamic stories of advancing from deeply oppressive environments to living out their wildest dreams.

Fundamentally, the message of hip-hop is one of hope.

Thus, hip-hop has the effect of “positive visual imagery,” helping people see the light when the whole world feels dark.

In other words, during bipolar episodes or periods of depression, listening to hip-hop can help people visualize or imagine a more positive place and where they’d like to be in the future. In turn, they arrive at a more secure mental state.

The study was conducted by neuroscientist Dr. Becky Inkster and psychiatrist Dr. Akeem Sule.

As Dr. Sule puts it:

Much of hip-hop comes from areas of great socioeconomic deprivation, so it’s inevitable that its lyrics will reflect the issues faced by people brought up in these areas, including poverty, marginalization, crime and drugs.

We can see in the lyrics many of the key risk factors for mental illness, from which it can be difficult to escape.

Hip-hop artists use their skills and talents not only to describe the world they see, but also as a means of breaking free.

We believe that hip-hop, with its rich, visual narrative style, can be used to make therapies that are more effective for specific populations and can help patients with depression to create more positive images of themselves, their situations and their future.

One of the prime examples utilized in the study is that of the Notorious B.I.G.’s “Juicy,” a hip-hop classic.

In the song, Biggie details his rise from deprivation on the harsh streets of Brooklyn to the covers of magazines and a life of affluence. It’s a song about making it against impossible odds.

There are so many other examples like this within the world of hip-hop. From Jay Z’s “On To The Next One” to the more recent Kendrick Lamar track, “i.”

Interestingly enough, not long ago, Lamar stated he penned the song as a form of encouragement and inspiration for prison inmates and suicidal teenagers:

I wrote a record for the homies that’s in the penitentiary right now, and I also wrote a record for these kids that come up to my shows with these slashes on they wrists, saying they don’t want to live no more.

Accordingly, it’s apparent some hip-hop artists are already deliberately attempting to help people with mental illness.

Regardless of the criticism it receives, hip-hop is a form of artistic expression with limitless educative and therapeutic potential.

The rapper Killer Mike has noted there is a commonly held view that hip-hop poses a threat or danger to society, but as he explains:

The kids spending hours per day writing rap songs aren’t a threat to society; they are often trying to escape the threats from society.

It's Interesting

Tag: hope

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