Trudi Jane Wyatt, MA, RP, CCC
Registered Psychotherapist (Ontario)

Psychotherapy over the telephone for individual male and female adults in Ontario, Canada. (I call from Alberta.)

trudistrasberg-new-head-shot-2016

416-901-0994 No text; if emergency 911; see ‘Resources’.

By appointment only. Weekdays, daytime (M-F) or evening (M-Th).

You might wonder about things like is psychotherapy by phone really helpful, because maybe you’ve only seen therapy “in the movies” and it’s done in person. And maybe you have only ever heard of mental health issues framed in medical terms like “diagnosis” or “brain disease”, and don’t realize that there is actually rich debate in the professional community as to whether and to what extent the medical terms apply. This is all understandable. The following links might help expand your awareness of these and other types of interesting topics being explored today in the profession:

Supporting the use of the telephone for psychotherapy:

A study in the journal “Psychological Services” concluding that “There was sufficient evidence to support VTC and telephone-delivered interventions for mental health conditions”:

https://pubmed.ncbi.nlm.nih.gov/29809025/

Exploring the nature of mental distress:

  • This article, “Messaging in Biological Psychiatry: Misrepresentations, Their Causes, and Potential Consequences”, in The Harvard Review of Psychiatry (Vol.28, Issue 6, Nov/Dec 2020), concludes in its Abstract (the summary the authors provide) that, “Public information about mental health should avoid these reporting biases and give equal consideration to the biological, psychological, and social aspects of mental health.” More quotes are copied and pasted below, as is the link to the full article. Note please see the full article for the 100+ citations therein, as they did not copy/paste well. Please see disclaimer below such as this is not medical advice and to consult with your physician before making any changes to medication as doing so can be dangerous or life-threatening.

Citing a New England Journal of Medicine article, the authors re-print, “Ironically, although these limitations [of “biologic treatments”] are widely recognized by experts in the field, the prevailing message to the public and the rest of medicine remains that the solution to psychological problems involves matching the “right” diagnosis with the “right” medication. Consequently, psychiatric diagnoses and medications proliferate under the banner of scientific medicine, though there is no comprehensive biologic understanding of either the causes or the treatments of psychiatric disorders.”

“we do not intend to question biological psychiatry per se, but the message delivered to the public. Psychotropic medications do alleviate psychiatric symptoms. For example, psychostimulants effectively treat attention-deficit/hyperactivity disorder (ADHD). It is questionable, however, to promote this treatment by asserting that it corrects an underlying dopamine deficit, although this claim has been often put forward by mass media”

“For example, among a total of 74 randomized, controlled trials of antidepressants registered with the FDA, 37 of the 38 trials reporting a positive effect were published in peer-reviewed journals. By contrast, among the 36 trials judged as negative by the FDA, 22 had not been published, 11 were published but reported positive outcomes, and only 3 trials published results in agreement with the FDA’s judgments.”

“For example, a study published in 1999 concluded that the brain level of the dopamine transporter is 70% higher in patients suffering from ADHD. This article was widely covered by the lay press because it claimed to reveal the biological cause of ADHD and to demonstrate the merits of psychostimulant medication, which inhibits the dopamine transporter. In their 1999 article, the authors failed to specify that four of their six patients had a previous history of psychostimulant therapy. Subsequent studies have shown that the brain level of the dopamine transporter is similar in controls and in untreated ADHD patients and that prolonged psychostimulant treatment increases this level.”

“For example, the most robust difference between the brains of depressed patients and those of healthy controls relates to the volume of the hippocampus. A large, international study showed that this volume reduction is modest (1.2%) and appears only after years of depression. It is not observed in patients diagnosed with a first depressive episode. Consequently, this minimal atrophy of the hippocampus might be
the consequence of chronic depression rather than its cause.”

“For example, among 46 initial studies reporting a significant
association between a genetic risk and a psychiatric disorder, only three (7%) were confirmed … [and further,] most initial studies in psychiatry appeared underpowered to detect small genetic risks.”

“newspapers strongly favor studies published by prestigious scientific journals, even though the initial studies that they publish are as often disconfirmed by subsequent studies, as are the initial studies published by journals with lower impact factors. Newspapers preferentially cover these initial studies because these prestigious journals also produce press releases highlighting the studies they publish. Indeed, these press releases are the direct source of more than 80% of the press articles reporting biomedical findings. Moreover, most newspaper articles are very closely inspired by these press releases and take up their biases and exaggerations without criticism”

“Although laypeople adhering to this belief tend to blame patients less for their symptoms, they perceive them as more dangerous and are more pessimistic about a possible recovery”

“Finally, expected stigmatization discourages patients from seeking help.
Altogether, this neuro-essentialist conceptualization negatively affects several aspects of stigmatization, reduces the chances of patients’ healing, and overshadows psychotherapeutic and social approaches that have been found effective in alleviating mental suffering”

“Actually, some rare genetic variants appear to be strongly associated with intellectual disability, autism, and schizophrenia, but they explain only a small percentage of cases. Recent genetic and epidemiologic studies have softened the view that genetic defects play a major role in the etiology of mental disorders.”

“Fourth, recent attempts to disentangle genetic from environmental components in the etiology of mental disorders have taken advantage of natural experiments and provided convincing evidence that psychosocial
conditions play a major causal role, at least for some disorders, such as the familial transmission of major depression.”

“A survey of Belgian, Canadian, and Israeli politicians showed “that a piece of information gets more attention from politicians when it comes via the media rather than an identical piece of information coming via a personal e-mail.”

“Indeed, national newspapers preferentially cover biomedical publications whose authors are working in that country.”

“…mass media almost never inform the public when a study that they have covered is disconfirmed by subsequent studies—which often happens, including for psychiatry. For example, the genetic susceptibility to depression reported by Caspi and colleagues was covered by 50
newspapers articles during the week following its publication, whereas subsequent studies that disconfirmed it received no media attention.”

“one might wonder why this reductionist discourse is so successful in democratic societies, especially since we now have strong evidence
that psychosocial risk factors play an important role in the etiology of common mental disorders. Most of these factors are, in fact, linked to the relative economic level of the subjects: the greater the inequalities in a
territory, the higher the prevalence of mental disorders in the most disadvantaged population. Some biological correlates of this relationship have been described and further reinforce the plausibility of a causal
relationship between relative poverty and mental disorders*. The neuro-essentialist discourse pushes aside this relationship by suggesting that academic and social failures, which are actually more frequent in
disadvantaged children, result from their intrinsic neurodevelopmental dysfunctions of genetic origin. Therefore, this discourse could mask the contradiction between the democratic ideal of equal opportunity at
birth and the fact that disadvantaged children are even less likely than before to climb the social ladder.”

*The Abstract to one of the cited references (Hackman et al., 2010) is: “Human brain development occurs within a socioeconomic context and childhood socioeconomic status (SES) influences neural development–particularly of the systems that subserve language and executive function. Research in humans and in animal models has implicated prenatal factors, parent-child interactions and cognitive stimulation in the home environment in the effects of SES on neural development. These findings provide a unique opportunity for understanding how environmental factors can lead to individual differences in brain development, and for improving the programmes and policies that are designed to alleviate SES-related disparities in mental health and academic achievement.”

The full article (and all citations within, over 100 of them, which do not copy/paste well in the above) can be found here: https://journals.lww.com/hrpjournal/Fulltext/2020/11000/Messaging_in_Biological_Psychiatry_.4.aspx#JCL-P-34

Please see disclaimer below such as this is not medical advice and to consult with your physician before making any changes to medication as doing so can be dangerous or life-threatening.

  • The “CEP” (Council for Evidence-based Psychiatry) writes a publicly-available paper (2014) exploring the idea of genetic involvement in experiences like depression. At the end it concludes that, “all anyone can say [is that]: of course our biology is implicated in mental distress, just as it is implicated in any emotional, physical or mental state that is experienced as either positive or negative. But precisely how it’s implicated, and precisely to what degree, we do not really know.” The link is below. I had difficulty pasting it as a URL for some reason, so I pasted it with Link Text, but you can just go directly to the website (cepuk.org) if you’d prefer and then click on the “unrecognised facts” tab to find the article yourself.

Link to CEP article

Exploring the applicability of the concept of “diagnosis” in mental health care:

  • A study in the journal “Psychiatry Research” about which “Lead researcher Dr Kate Allsopp, University of Liverpool, said: ‘Although diagnostic labels create the illusion of an explanation they are scientifically meaningless and can create stigma and prejudice. I hope these findings will encourage mental health professionals to think beyond diagnoses and consider other explanations of mental distress, such as trauma and other adverse life experiences.’”:

https://www.sciencedaily.com/releases/2019/07/190708131152.htm

  • The British Psychological Society / Division of Clinical Psychology published a leaflet entitled “Understanding psychiatric diagnosis in adult mental health” that is written in Q&A format. It starts off by explaining that, “There are many different opinions about psychiatric diagnosis in adult mental health, just as there are many different ways of thinking about distressing or unusual experiences. The aim of this leaflet is to help you to think about diagnosis and whether other kinds of explanation make more sense and give a better understanding of you as an individual. Whatever your viewpoint on diagnosis, all of us can experience very real distress and difficult circumstances, which can significantly disrupt our lives.”

https://www.bps.org.uk/sites/www.bps.org.uk/files/Member%20Networks/Divisions/DCP/Understanding%20psychiatric%20diagnosis%20in%20adult%20mental%20health.pdf

  • One of the main texts of one of the main approaches to counselling/psychotherapy today called “Acceptance and Commitment Therapy” describes that*:

“Given the extraordinary attention lavished on the abnormality model within psychology and psychiatry, it is surprising to note that virtually no progress has been made in establishing mental health syndromes as legitimate disease entities (Kupfer, First, & Regier, 2002). After relating the well-worn and dated example of general paresis, there are virtually no other success stories to tell. Unfortunately, this lack of success does not keep scientists from insisting that these psychological syndromes will soon represent discrete disease entities… The ‘comorbidity’ rates among disorders are so high as to challenge the basic definitional integrity of the entire system… The system dismisses key forms of suffering (relationship problems, existential crises, behavioural addictions, and so on), and even its advocates agree that at times it seems to pathologize such normal processes of living as grief, fear, or sadness (Kupfer et al., 2002).”

*Acceptance and Commitment Therapy, 2nd Ed. (Hayes, S.C., Strosahl, K.D., & Wilson, K.G., 2012), pp.7-8 in section entitled, “The Myth of Psychiatric Disease”.

This page is for information only, and is not advice of any kind (e.g., it is not medical advice — please consult with your physician if you require medical advice such as regarding any medication you are taking, as it can be dangerous to make any changes to these without medical supervision). It is neither counselling nor psychotherapy and implies neither an intent to provide professional services to readers nor that a professional relationship has been established with readers. If you need these services, please contact me or another professional. If urgent support is needed, calling Toronto Distress Centre at 416.408.4357 is an option. For emergencies, consider calling 911 or going to your local Emergency Room. Current adult residents of the Canadian province of Ontario are the only intended audience of this page.

Trudi Jane Wyatt, MA, RP, CCC © 2020