The Equalizing Power of Grief

Grief therapy is fundamentally different from other kinds of therapy for a few reasons, a primary reason being that both the therapist and the client have had their own experiences with grief and loss. In other therapies, the client may have a problem that the therapist has never experienced, so the therapist is operating purely clinically with no personal interjection.

This different way of doing therapy can feel odd to those who are more comfortable in a therapeutic experience that is more one-sided and hierarchical with the therapist being the expert on treatment and the client bringing the issue to be treated. With grief, we are all in the same boat. Not that your therapist will give great detail about their own story- therapy should always center on you as the client- but there is a different sense of community, a feeling like right now it is you going through this grief, but we have both been there and we will both be there again at many points in our lives.

And so, grief therapy is a process grounded in a horizontal relationship of equality rather than a vertical relationship of hierarchy and expertise. We are truly traveling together on the journey of grief. This is a collaborative process of digging into the meaning and purpose of life in the face of our mortality and limits.

About Anxiety Disorders

Anxiety disorders are common. Learn about the three types of anxiety and the best ways to treat them in this introductory post.

Anxiety

Along with depression, anxiety disorders are the most prevalent of all mental health problems. The majority of people, sometimes estimated as high as 80%, will experience clinically significant anxiety during their lifetimes.

What Causes Anxiety?
There are a number of possible causes for anxiety. The three general categories are environmental, biological, and psychological. A serious anxiety disorder may involve one source or several. Different treatments will be more or less effective depending on the reason for your anxiety. Talking with a therapist about your anxiety can help you identify the reason for your anxiety and how it can be treated.

Environmental anxiety comes up when you are in a stressful situation. Outside stressors from your personal life, work, school, or home can result in clinically significant anxiety. When you deal with the stress, either by managing the situation or increasing your coping skills, the anxiety usually diminishes or goes away. Therapy can help you find ways to manage your environment to reduce stress. A therapist can also help you develop skills to increase your internal resilience to stressful situations that you can’t control and come up with things you can do to manage your feelings of anxiety in those situations.

Biological anxiety is caused by neurochemical imbalances in your brain that result in you feeling anxious even though there is no apparent reason for the feeling. These imbalances can happen for a number of reasons, and they can be treated by re-balancing your neurotransmitters through medication. There are several different kinds of medications that can be effective, and your doctor or psychiatrist can walk you
through your options. You may also benefit from therapy even with medication because when you experience anxiety, you can learn negative thought patterns that may continue even on medication.

Psychological anxiety is the result of your thought patterns. When you focus on anxiety-provoking thoughts, you begin to feel anxious. The feeling of anxiety reinforces the negative thought patterns which results in feeling even more anxiety. This kind of anxiety is treated best with therapy, though you may need medication to help break the cycle of negative thoughts before therapy is effective. Therapy can help you change the way you think to help you feel better.

Any questions about anxiety you want answered by a therapist? Leave a comment below or send a message and we may feature your question in a future post.

Treating Refractory Schizophrenia

Refractory schizophrenia occurs in about 30% of cases. When medication doesn’t work, traditional therapy can still be effective.

I’ve recently had a few new people come in for therapy with diagnoses on the schizophrenia spectrum. Not only that, but they’ve tried a few different medications with no significant reduction of symptoms. Refractory is just a fancy way of saying treatment resistant.

As a therapist, when I hear that my new clients have treatment resistant schizophrenia, my first thought is this- Can therapy help someone who isn’t helped by medications? After all, schizophrenia is a pretty major mental illness.

It’s not like depression or anxiety where the cause could be either biological or psychological, and the origin of the symptoms shapes treatment. Instead, schizophrenia is understood as a primarily biological disorder with clear ties to dysfunction in major brain systems.

With schizophrenia, medication works to relieve symptoms in approximately 70% of cases. That’s a much lower number than I expected. That means 30% of people who experience schizophrenia get little to no help from medications. There’s a lot we don’t know about schizophrenia though, so we could see that number decrease as we learn more about the brain and how it works in mental illness. In fact, I just read an article today about scientists searching for brain cues related to major mental illness. They discovered tons of tiny factors that all play into the etiology and course of major mental illness.

But that’s a bit of a tangent. My goal was to learn if there were any therapy interventions that were designed to work for people with refractory (treatment resistant) schizophrenia spectrum disorders.

I was actually surprised to find that this has been studied by a few different researchers. I found two different treatment protocols based on CBT that were demonstrated to be effective with refractory schizophrenia. They seemed similar, with slight differences. I figured it would be easy to combine these approaches and create a protocol of my own that will hopefully be effective in my three new clients.

I’ll post the full protocol in a separate post. For now, here are the two studies I used to develop this method of treatment for refractory schizophrenia.

 

Cognitive–behavioural therapy for refractory psychotic symptoms of schizophrenia resistant to atypical antipsychotic medication. Lucia R. Valmaggia, Mark Van Der Gaag, Nicholas Tarrier, Marieke Pijnenborg, Cees J. Slooff. The British Journal of Psychiatry Apr 2005, 186 (4) 324-330; DOI: 10.1192/bjp.186.4.324
The omnipotence of voices. A cognitive approach to auditory hallucinations.. P Chadwick, M Birchwood. The British Journal of Psychiatry Feb 1994, 164 (2) 190-201; DOI: 10.1192/bjp.164.2.190