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When people come to treatment, they will often ask me to recommend books that they might read to assist them in solving the problems that are challenging their lives. They gaze at the books, which line the shelves in my office, possibly expecting that some perfect kernel of wisdom is hidden within one of those tomes (if paperbacks can be tomes).

They search for that one statement, or fact, which absolutely and clearly elucidates their particular problem and explains the exact formula for a quick and enduring fix. “Give me something to read,” they ask. Sometimes I say: “if you could get all of the answers from books, we wouldn’t need therapists!”

At times, however, I do recommend certain books and we will discuss some of them in this forum from time to time.

When my family goes shopping , I find the opportunity to wander over to one of the major bookstores to check out Randy Wayne White’s latest mystery novel. His books invariably start in one of my favorite fishing haunts, Tarpon Bay ,a mangrove lined province of snook, redfish, porpoises  and manatees. But my “psychological roots” drag me to the “Self Help” and “Psychology” section where I am faced with a plethora of books urging me to experience my “primal chuckle’ or allowing my “inner child’ to find his “happy place.”

I  keep looking, and find some classics that I paid big bucks for when I was in school. Now, they are just a few dollars for the paperback edition and still valuable sources of knowledge.  I look a bit further, my neck muscles crimping as I try to read the titles sideways.

There are books on anger, love, depression – just about every emotion and personality disorder that human beings can experience.

There are books on relationships –  they catch my attention. John Grey suggests that men and women come from different planets (I will discuss and recommend Dr. Grey at another time). I find that Mars and Venus meet, go on a date, they get married, and they collide. Eventually, I think to myself, they settle down, after a successful course of marital therapy, to live their lives helping their kids pay off their student loans. I keep searching for that book with the kernel of wisdom.

Some of the books in the self-help/psychology section are written by well- known and highly respected members of the scientific community. They provide valuable information for any serious student of psychology.

There are books written by the “stars’ of the profession – like Dr. Phil. Isn’t it amazing that he can “fix” someone’s problem in fifteen minutes? Actually, some of his books provide basic, common sense, approaches to many of life’s problems.

Then, there are the books that are written by writers – not psychologists, psychiatrists or social workers. These authors go out and interview a bunch of people (not a representative sample) who have experienced the same problem, and write a book about it.

In other cases, an actor, media personality or just  “one of us” experienced something in their lives and now, trying to “work through” their problem, writes a book about it. I tend to be a bit skeptical of the guidance provided by these authors.

I finally hit the wall when I found a self-help book on self-help books! It was a guide to all the rest of the books on the shelf. I didn’t read it but I did pause to give my neck a rest. Again, I considered the thought that if people could get all of this enlightenment and understanding from books we would not need therapists.

My concerns were diminished when I met a couple that had been referred by their therapist who was on holiday and did not want to leave this couple without some therapeutic support while he was out of town. Archie and Edith (not their real names) apparently argued all of the time. He was experiencing a mid-life crisis (self-diagnosed) and had left his wife, quit his job, purchased a sports car, and had become involved with a younger woman.

She, the younger woman, had thought him quite charming and had entered the relationship. Their arguments had escalated and they had sought help from an experienced therapist.

After briefly explaining their problems to me, she showed me a book (The Dance of Anger – to be discussed in another column) in which she had underlined what she considered the salient factors –which she proceeded to read to him in a loud accusatory voice.

The following week, they returned and he, having also read and underlined passages in the book, read what he considered the salient facts to her – in an accusatory voice.

They had each underlined different points –extracting only those facts that supported each of their positions. In other words, they each saw what they wanted to see.  No insight, no enlightenment and no modification of the couple’s psychodynamics or their cognitive approach to one another.

Bibliotherapy, as it is called, can be an extremely useful adjunct to the therapeutic process – but it isn’t therapy. It is the therapist’s knowledge and experience, the use of proven techniques of treatment (including medications) and the nature and dynamics of the therapeutic relationship that can help the patient to integrate and synthesize information from various sources.

If patients are motivated to learn more, there are certainly a plethora of books waiting on the shelves of your local bookseller. But remember, when you choose, choose wisely.

About the author: Charlie

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Dream a Little Dream

It is common practice in psychoanalysis for the patient to report the content of dreams as part of treatment. Sigmund Freud believed that dreams were a window into the unconscious mind. Therefor, by understanding and interpreting the content of dreams the patient would reveal thoughts and images that would possibly clarify current or past experiences, feelings and actions.

Dream analysis, once in vogue for both patients and doctors, has given way to what is termed cognitive-behavioral therapy, or CBT. A CBT approach to treatment might view dream content as random neural activity. However, if one considers the complexity of our dreams and the fact that there are repetitive themes and images,frankly, that hardly seems “random.” CBT examines cognition,our manner of thinking about issues. It also evaluates and treats behavioral concerns, like nail biting, smoking or other compulsive behaviors. Dream analysis is more within the realm of psychotherapeutic approaches that incorporate a deeper analysis of the complex developmental issues, or psychodynamics, which are the causal basis of personality and cognitive concerns.

The dream is divided into two components. The first level of analysis is the manifest content ( which is the actual experience of the dream). “I was driving my car down a mountain road and I had no brakes!” The second level is the latent content of the dream,( what the dream really means). In this case it might be a feeling of loss of control or an inability to control something. We dream in symbols. If we identify certain people in the dream that image could be a “stand-in” for someone else. Dreaming about snow could represent depression or a desire to “cover up” something or jus a pleasant memory of childhood.. So, how do we know the “correct” interpretation? The symbolic items in the dream can be better understood if interpreted within the context of that particular person. Freud suggested that we dream in symbols to “protect” our sleep. If we see through the symbolic process it can cause anxiety and would awaken us, possibly identified as a nightmare.

Dreams can be viewed as the dreamer’s attempt to “work through” or resolve some conflict that they are experiencing in reality. Another aspect of the dream is “wish fulfillment.” Within a dream one can see themselves mastering a task or problem. Apparently, we experience dreaming several times on most nights, even if we do not recall the experience. However, some medications can interfere with neurological function and inhibit dreaming. Interestingly, we seem to have a need to dream.In a classic study people were awakened as they began to dream.It was easy to identify the dream state since dreams are accompanied by rapid eye movements that can be identified and recorded. This procedure occurred for several days. Finally when the subjects were allowed to sleep, their number and frequency of dreams increased. Deprived of dreams, people began to dream more; possibly to make up for the deficit. Dream deprivation increases dreaming when subjects are permitted to have normal sleep.

Finally, dreaming is the only time that we can really “time travel.” One can be a young child in the dream and instantly become a teen or young adult. While the meanings in dreams may be elusive, they can provide meaningful thoughts and ideas that can help the patient to overcome the challenges and the demands of life that have brought them to treatment.

The Columbia Counseling Center offers an eclectic and integrated approach to treatment. The doctors on our staff are trained in the use of multiple techniques and strategies to relieve anxiety, improve mood and effectively modify coping strategies.

You can call 410 992 1949 for the first available appointment.

The Serotonin – Depression Connection

Recent articles( such as this piece from psychcentral.com have posited the notion that serotonin is not a significant component of the depressive process .Further, that drug companies, having developed serotonin enhancing medicines, began an advertising campaign to “convince” the public that serotonin was the “cure” for depression.The idea that drug companies would conspire to mislead the public is quite questionable ( although I do enjoy a good conspiracy theory). One of the problems is that we cannot measure serotonin in the brain directly. Further, if we manipulate serotonin with an SSRI (selective serotonin re-uptake inhibitor), this also disturbs the balance of norepinephrine and dopamine- two of the major neurotransmitters. Now, it is really more complicated than this. There are many sub-types of each of these substances so it is not a simple matter of manipulating one of these chemicals.There are also many sub-types of receptor sites in the brain. The more we learn about the chemistry and structure of the brain, the more complicated it becomes.

The data from numerous studies indicates that psychotropic medications may only work about 50% of the time. In addition, psychiatrists may have to try a number of different medications in order to gain a positive effect. Of course, patient compliance is always a problem. It is not a good idea to wash your Prozac down with scotch whiskey – but I have had a number of patients who have done just that!

Michael Greger points out that diet ( whole food plant based nutrition) and exercise may be just as effective as some anti-depressants. While there is merit to this assertion, trying to get a depressed patient to exercise and eat properly is quite challenging – to say the least! It is my impression that “comfort foods” carbohydrates, potatoes, bread, mac and cheese act as “comfort foods” because they do, in fact, raise serotonin levels along with a number of other “calming” chemicals (such as tryptophan) that do cross the blood-brain barrier. Unfortunately, a bag of potato chips only increases serotonin levels for a couple of hours.

It does appear that cortisol is a precipitating chemical in the depressive process and influences a decrease in certain neurotransmitters. Indeed, being in a stressful situation for two to six weeks can trigger a depressive episode. This is chemistry, not “psychological” weakness. The notion that neurotransmitters are the causal factors in the depressive process is strengthened by the apparent genetic relationships within families. If we examine the family of origin of a depressed patient we will find both genetic and psychogenic factors that contribute to the depressive process. Further, it is interesting to note that if a particular antidepressant medication is effective for a “blood relative” ( biological parent or sibling) there is a high probability that the medicine will be effective for the patient.

The “holy grail” of treatment for depression will not be easily discerned. Light therapy can be effective. Likewise, trans-cranial stimulation shows promise. Various approaches in psychotherapy can be quite effective. However, anti-depressant medicines will continue to be a major component of treatment.Columbia Counseling Center’s integrated treatment protocol carefully evaluates the multiple causal factors in depression and provides both pharmacological and psychotherapeutic approaches for maximum effective treatment of depression.
Call 410 992 9149 for the next available appointment.

The Most Powerful Treatment for Depression

The title of this 2008 study says it all: “Faster remission of chronic depression with combined psychotherapy and medication than with each therapy alone”. The study of over 650 patients with depression compared medication treatment alone to medication treatment plus psychotherapy. The results were clear: patients on medication and therapy recovered from chronic (meaning repeated episodes of) depression faster than patients on either treatment alone.

Many studies over the years have identified both cognitive-behavioral therapy and interpersonal psychotherapy as being just as effective as medication in reducing symptoms of moderate depression. Other studies have shown that the improvements gained in therapy alone can last longer than the improvements gained from medication alone.

In my opinion, it’s the minority of cases that improve on just medication. The job of antidepressant medicine is to reduce the most immediate and troubling symptoms that interfere with your ability to function at home, at work, and socially: low energy, loss of interests, poor concentration, crying spells, hopelessness, and suicidal thoughts. The job of therapy is to identify the life issues that have led to depression and make changes in how you deal with those issues so they stop depressing you.

Therefore, we have two powerful and effective tools to treat depression. Use them together and you are likely to get the fastest and most enduring relief from your symptoms. At Columbia Counseling Center, the psychiatrists and therapists are all under one roof and we work with each other to ensure that your treatment is coordinated and efficient.

Written by: Dennis Glick, M.D. Board Certified Psychiatrist at The Columbia Counseling Center

Generalized Anxiety Disorder (GAD) is a common and recurring condition. Typical symptoms include near-daily worry, anxiety, tension, feeling on edge, irritability, and sleep disturbance. Features of panic attacks and/or social anxiety may also be present. Your primary care doctor may have already ruled out medical causes such as thyroid, electrolyte, cardiac, or nutritional abnormalities.

Cognitive-behavioral therapy (CBT) is a very effective form of treatment, typically requiring 6 to 12 weekly sessions that may include the use of workbooks and homework. The SSRI and SNRI antidepressant medications (Prozac, Paxil, Zoloft, Celexa, Lexapro, Effexor, Cymbalta, and Pristiq) are highly effective and should be continued for a period of 6 to 12 months following symptom reduction. Benzodiazepines such as Xanax, Ativan, and Klonopin are best used on a temporary basis due to the risks of addiction, memory impairment, physical incoordination, and potentially endangering combinations with alcohol and pain killers. Other medicines such as Buspar, Vistaril, Gabapentin, and Seroquel are occasionally used but are not specifically approved for treatment of GAD.

Many patients will benefit from the combination of CBT and medication. The Columbia Counseling Center is uniquely able to provide coordinated treatment as our staff includes both psychiatrists and psychologists specifically trained to diagnose and treat GAD and other anxiety and mood disorders. Your clinicians work together to ensure you are receiving the most effective treatments for your condition.

Conflict Resolution vs Separation

By Dr. Susan Minsky

Couples often believe the easiest solution to frequent arguments that appear unresolvable is to threaten separation and divorce. Divorce is the last choice to resolve what initially may appear as unreconcilable differences. Marriages require the willingness on both parties to rebalance needs, expectations, hopes, on a consistent basis at various stress points and change which occur throughout a long term relationship. Clear, direct communication, hearing each other in an accurate manner is necessary to produce effective changes for both parties. Couples often require refresher courses and new skills to promote a growth oriented exchange during stressful times, in particular.

Come join the Columbia Counseling Center team who provide an integrated approach to promoting and strengthening the bonds between partners in relationships. Individual and couples therapy are offered simultaneously to promote more rapid and productive identification of issues that require resolution to enhance the lost intimacy and positive communication and interaction between partners.

 

 



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