1. 1. CONCERN, FLAVOUR, AND VALUES: BEYOND THE DODO'S VERDICT Digby Tantam Director, Septimus Ltd Emeritus Professor, University of Sheffield Honorary Visiting Senior Research Fellow, University of Cambridge
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3. 3. 3 Psychotherapy is a general term for treating mental health problems by talking with a psychiatrist, psychologist or other mental health provider. During psychotherapy, you learn about your condition and your moods, feelings, thoughts and behaviors. Mayo Clinic
4. 4. 4 Psychotherapy is a general term for treating mental health problems by talking with a psychiatrist, psychologist or other mental health provider. During psychotherapy, you learn about your condition and your moods, feelings, thoughts and behaviors. Mayo Clinic
5. 5. PSYCHOTHERAPY CONTEXT 1. Psychotherapy is effective 5
6. 6. AMERICAN PSYCHOLOGICAL ASSOCIATION RESOLUTION ON THE RECOGNITION OF PSYCHOTHERAPY EFFECTIVENESS, 2012 HTTP://WWW.APA.ORG/ABOUT/POLICY/RESOLUTION-PSYCHOTHERAPY.ASPX WHEREAS: the effects of psychotherapy are noted in the research as follows: The general or average effects of psychotherapy are widely accepted to be significant and large, (Chorpita et al., 2011; Smith, Glass, & Miller, 1980; Wampold, 2001). 6
7. 7. Click to edit Master title 7 WHO Europe http://www.euro.who.int/en/health- topics/noncommunicable-diseases/mental- health/data-and-statistics
8. 8. WHO WORLD HEALTH ATLAS, 2014, PUBLISHED 17 JUL 2015 www.existentialacademy.com 8
9. 9. PSYCHOTHERAPY CONTEXT 2. The benefit of short-term therapy 9
10. 10. The doseeffect relationship in psychotherapy. By Howard, Kenneth I.; Kopta, S. Mark; Krause, Merton S.; Orlinsky, David E. American Psychologist, Vol 41(2), Feb 1986, 159-164.
11. 11. The doseeffect relationship in psychotherapy. By Howard, Kenneth I.; Kopta, S. Mark; Krause, Merton S.; Orlinsky, David E. American Psychologist, Vol 41(2), Feb 1986, 159-164. Remoralization Symptom change Improvement in life-functioning
12. 12. PSYCHOTHERAPY CONTEXT 3. There is a large placebo effect 12
13. 13. THE EFFECTS OF PSYCHOTHERAPY: AN EVALUATION. EYSENCK, H. J. JOURNAL OF CONSULTING PSYCHOLOGY, VOL 16(5), OCT 1952, 319-324. HTTP://DX.DOI.ORG/10.1037/H0063633
14. 14. Grossarth-Maticek, R., & Eysenck, H. J. (1995). Self-regulation and mortality from cancer, coronary heart disease, and other causes: A prospective study. Personality and Individual Differences, 19(6), 781-795. Grossarth-Maticek, R., & Eysenck, H. J. (1995). Self-regulation and mortality from cancer, coronary heart disease, and other causes: A prospective study. Personality and Individual Differences, 19(6), 781-795.
15. 15. Kirsch, I., Deacon, B. J., Huedo-Medina, T. B., Scoboria, A., Moore, T. J., & Johnson, B. T. (2008). Initial Severity and Antidepressant Benefits: A Meta-Analysis of Data Submitted to the Food and Drug Administration. PLoS Med, 5(2), e45. doi: 10.1371/journal.pmed.0050045
16. 16. PSYCHOTHERAPY CONTEXT 4. There is a large non-specific effect of common factors 16
17. 17. THE DODO BIRD VERDICT
18. 18. THE DODO BIRD VERDICT
19. 19. HTTP://WWW.APA.ORG/ABOUT/POLICY/RESOLUTION-PSYCHOTHERAPY.ASPX These large effects of psychotherapy are quite constant across most diagnostic conditions, with variations being more influenced by general severity than by particular diagnosesThat is, variations in outcome are more heavily influenced by patient characteristics e.g., chronicity, complexity, social support, and intensityand by clinician and context factors than by particular diagnoses or specific treatment "brands" (Beutler, 2009; Beutler & Malik, 2002a, 2002b; Malik & Beutler, 2002; Wampold, 2001) 19
20. 20. Imel, Zac E; Wampold, Bruce E (2008). "The importance of treatment and the science of common factors in psychotherapy". In Brown, Steven D; Lent, Robert W. Handbook of counseling psychology (4th ed.). Hoboken, NJ: John Wiley & Sons. pp. 249262. Up to 70% of the variance of the effects of psychotherapy Jerome Frank. Persuasion and healing First attempt to formulate universal therapeutic factors for combatting demoralization 20
21. 21. PSYCHOTHERAPY CONTEXT 6. Some people get worse with antidepressants and psychotherapy, which effects estimates of outcome variance 21
22. 22. PSYCHOTHERAPY CONTEXT 7. Many people drop out or are non- compliant with all mental health or psychological treatments 22
23. 23. NON SPECIFIC EFFECTS OF PSYCHOTHERAPY Persistence in therapy The therapeutic relationship Lindfors, O., Knekt, P., Heinonen, E., Hrknen, T., & Virtala, E. (2015). The effectiveness of short- and long-term psychotherapy on personality functioning during a 5-year follow- up. Journal of Affective Disorders, 173, 31-38. doi: 10.1016/j.jad.2014.10.039
24. 24. Click to edit Master title Symptoms versus predisposition Symptomatic treatments are short-term, dispositional change is long-term Symptoms are not the only outcome Well-being Quality of life Relationship quality 24 SPECIFIC EFFECTS
25. 25. From: A Randomized Controlled Trial of Psychoanalytic Psychotherapy or Cognitive-Behavioral Therapy for Bulimia Nervosa American Journal of Psychiatry FIGURE 2. PERCENTAGE OF PATIENTS REPORTING NO BINGE EATING OR PURGING OVER THE PREVIOUS 28 DAYS AND MEAN EATING DISORDER EXAMINATION (EDE) GLOBAL SCORES a N=70; missing values replaced by last observation carried forward. Copyright American Psychiatric Association. All rights reserved. Date of download: 07/24/2015
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27. 27. Click to edit Master title People persist in therapy if it addresses their preoccupying concern Therapists who are effective in the area of preoccupying concern will have better outcomes because: a. Their clients will stick with them; b. They will receive more of any specific effect 27 PRE-OCCUPYING CONCERN
28. 28. SPECIFIC EFFECTS OF EXISTENTIAL THERAPY What pre-occupying concern does existential therapy address?
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30. 30. 1) People possess orienting systems (global meaning) that provide them with cognitive tools to interpret their experiences and motivate their functioning in the world. 2) People appraise the situations that they encounter, assigning a meaning to them. 3) The extent to which that appraised meaning is discrepant with their global meaning determines the extent to which they experience distress. 4) The distress caused by discrepancy initiates a process of meaning making. 5) There are many ways to make meaning. 6) Through meaning making, individuals reduce the discrepancy between appraised and global meaning and restore a sense of the world as meaningful and their own lives as worthwhile. 7) Meaning making, when successful, leads to better adjustment to the stressful event PARK, C. L. (2013). TRAUMA AND MEANING MAKING: CONVERGING CONCEPTUALIZATIONS AND EMERGING EVIDENCE THE EXPERIENCE OF MEANING IN LIFE: CLASSICAL PERSPECTIVES, EMERGING THEMES, AND CONTROVERSIES (VOL. 9789400765276, PP. 61-76).
31. 31. THE ROLE OF EXISTENTIALIST PHILOSOPHY Kierkegaard, and the abyss Nietzsche and his shame Edith Stein and her rejection by the University Even Heidegger and his discovery that he was not the father of his son, and his consequent loss of faith Sartre and his mothers remarriage
32. 32. A BIGGER CONCERN? The humdrum life could be a life of anxiety, conflict, addiction Kierkegaard called the aesthetic life Nietzsche: ressentiment Heidegger: fallenness, inauthenticity? Sartre Mauvaise foi: tre en soi, tre pour lautrui Emmy van Deurzen: self-deception. 34
33. 33. OTHER MATCHES BETWEEN CLIENT AND THERAPIST Matching values Palatable emotional flavour 36
34. 34. Freedom, Responsibility and the Meaning of Being A historic and unique gathering of existential therapists from across the world. OUR KIND SPONSORS
35. 35. DIGBY AND EMMY CO-CHAIRS AT THE OPENING SESSION.
36. 36. FIRST WORLD CONGRESS OF EXISTENTIAL THERAPY 39
37. 37. VALUES SYMPTOMATIC Symptoms are a problem to be fixed My life would be fine, except for the symptoms Ive got into bad habits or wrong thinking ET Freedom: Not living falsely Being engaged The ideality of values values derive their meaning from an original projection of myself which stands as my choice of myself in the world. Sartre, Being and Nothingness I am answerable for my own life to myself (Absurdity: do not look for justification in absolutes) Why I continue to live is not determined by other people That all human beings are intersubjectively connected
38. 38. EMOTIONAL FLAVOUR SYMPTOMATIC Calming Friendly Confident Relief ET Not at home Anguish Transcendence Resoluteness Satisfaction