Sunday, December 27, 2015

A Modicum of Wisdom

My supervisee asked me the other day what is the single most important advise I could impart to her. I have not thought of myself old enough to be wise yet, but I suppose 25 years seating in the therapist's chair qualify me for a claim to a modicum of wisdom.

So I meditated on the question: The image of a tree came to mind, more specifically the symbolic Tree of Life of the Cabbalah tradition. The idea is that the journey of spiritual evolution involves balancing pairs of opposites.

One of these pairs of opposites is Boundless Loving Kindness, and No More. Although it is always important to look inside and own our part and fault in a conflict, it is equally important not to own someone else's responsibility. Although empathy can liberate us from the shackles of rage and revenge, being able and willing to set firm boundaries and hold the other accountable is an expression of true intimacy. It communicates to our partner that we expect better and we believe he/she is capable of it.

So, what is a valuable piece of advise? Practice on finding the balance between empathy/love and self assertion. The main principle of homeopathic medicine is that the Poison that kills is also the Cure. Saying No often feels abrasive, but it is also the powerful cure that places the burden where it truly belongs and invites our partners in life to respect and honor our limits.

So, may the New Year find us a little bit more balanced.

Saturday, December 12, 2015

News and wishes from the Xmas tree


 With peace on earth, good will to men.

I had just hanged the last ornament on our office tree when the news about the shooting in California came in. I sat down is shock soon to be replaced by fear and sadness. Oh not again, I thought. Wordsworth's words resounded in my head:

And in despair I bowed my head:
'There is no peace on earth, ' I said
'For hate is strong, and mocks the song
Of peace on earth, good will to men.'

I looked at the tree, all bright and sparkling, through the veil of my tears and I pleaded with it to object, to pull me out of the dark and hopeless place.  It did, after all what kind of magic tree would it be if it hadn't. Wordsworth continued:

Then pealed the bells more loud and deep:
'God is not dead, nor doth He sleep;
The wrong shall fail, the right prevail, With peace on earth, good will to men.'

In a world where the Youth is disillusioned, God an excuse to act out homicidal rage and Heroes either absent or powerless to inspire and amaze may poetry keep Hope burning bright.

Sunday, July 26, 2015

Therapy or drugs?


Currently the way doctors prescribe psychiatric meds is pretty much the eeny, meeny, miny, moe way: We start with a little bit of this, we add a little bit of that and so on. This is because, with a few clinical exceptions, there is little evidence to favor one treatment over another for a given patient. This is changing however.

A recent study published in JAMA using PET scans, showed marked differences in brain activity in patients that responded better to cognitive behavior therapy as opposed to Lexapro.  Patients with low activity in the brain region called anterior insula responded quite well to behavior therapy but poorly to Lexapro.
In the near future scans will be able to tell us which therapy will be more effective with what mental conditions.

Another large, multicenter study conducted by Dr. Nemeroff, professor of psychiatry at Emory, found that in patients with a history of childhood trauma 48% achieved remission with cognitive therapy alone while only 33% responded to drugs alone. The combination of drugs and therapy was not significantly better than therapy alone. Considering the high rate of trauma and early childhood abuse in depressed people doctors will serve their patients better if they educate them about the benefits of therapy and encourage them to pursue it.