Psychotherapy is a fancy term for talking over anxieties and depressions
‘ GEE, Doc, you reckon I might need some psychotherapy? I dunno, that all sounds a bit weird to me.’’ In November, 2006, a new Medicare initiative called Better Access to Mental Health was launched. The aim was to improve access to a range of mental health practitioners, including GPs, psychiatrists and psychologists. Following a detailed assessment by their GP, patients can now be referred to psychologists under a mental health plan which entitles them to claim Medicare rebates for their psychologist consultations.
This change has been very popular. Around 600,000 services have already been provided by registered and clinical psychologists under these new arrangements.
While there is some concern that these services may be distributed unevenly, with middle-aged metropolitan people who already had relatively good access to psychologists being the biggest users rather than young people in the regions, there is no doubt the initiative has been a success.
Nonetheless, many people are still hesitant when you suggest they might benefit from a brief course of psychotherapy. Thanks to countless movies such as AnalyseThis and TV shows such as Frasier , many people still think of dream analysis, ink blots, Oedipus complexes and Sigmund Freud when they think about psychotherapy.
Freud developed and practised a specific type of psychotherapy called psychoanalysis. But while he remains an enormously fascinating and influential figure in the history of psychiatry, pure psychoanalytic practice is now much more common on the screen than it is in the consulting rooms of psychologists or psychiatrists.
So if not dream analysis, what can my patient expect?
There are many different types of psychological therapy — which may be delivered by a GP, a psychiatrist or a psychologist. In practice it really means just about any type of talking-based therapy.
This includes such simple, non-specific interventions as activity planning, sleep/wake cycle management, relaxation exercises and structured problem solving. If you can improve someone’s sleep, get them to exercise more and engage in social and usually pleasurable activities, and help them to relax and develop strategies for dealing with seemingly overwhelming ‘‘ real life’’ problems, you’re well on the way to improving their mental health.
Of the more specific ‘‘ brands’’ of psycho- logical therapy available, the most widely practised in Australia these days is cognitive behavioral therapy, or CBT for short. Its popularity stems both from the fact that it takes relatively little time — typically six to 12 sessions — and it has a robust evidence base. Many studies have shown it to be at least as effective as medication in treating mild to moderate depression and anxiety.
Although two US psychologists, Aaron Beck (born 1921) and Alfred Ellis (1913-2007), are widely regarded as the fathers of cognitive therapy, its basic paradigm can be traced back to the First Century stoic philosopher Epictetus, who claimed: ‘‘ We are disturbed not by events, but by the views which we take of them’’. Shakespeare echoed this thought in Hamlet when he wrote ‘‘ there is nothing either good or bad, but thinking makes it so.’’
While an anxious mood begets anxious thoughts, it’s also true that anxious thoughts can beget an anxious mood, and the same goes for depression. We often imagine the ‘‘ voice in our heads’’ passing judgment on ourselves and the world is the impartial mouthpiece of our authentic self, when it can be a highly biased propagandist for our mood disorder.
This biased, unrealistic thinking can trigger negative emotions, facilitate dysfunctional coping styles and express itself in counterproductive behaviours. By looking critically at our automatic reactions to distressing situations in terms of emotions, thoughts and subsequent behaviours, CBT offers the chance to develop flexible, realistic, less distressing responses.
CBT can be used in conjunction with medication or without. It’s not the only effective psychological treatment, nor does it work for everything or everybody. But if you have anxiety or depression, you’re more likely to start off dealing with an old Stoic than an old Viennese. Simon Cowap is a GP practising in Newtown, Sydney