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Psychodynamic psychotherapy is effective for a wide range of mental health symptoms, including depression, anxiety, panic and stress-related physical ailments, and the benefits of the therapy grow after treatment has ended, according to new research published by the American Psychological Association.

Psychodynamic therapy focuses on the psychological roots of emotional suffering. Its hallmarks are self-reflection and self-examination, and the use of the relationship between therapist and patient as a window into problematic relationship patterns in the patient’s life. Its goal is not only to alleviate the most obvious symptoms but to help people lead healthier lives.

“The American public has been told that only newer, symptom-focused treatments like cognitive behavior therapy or medication have scientific support,” said study author Jonathan Shedler, PhD, of the University of Colorado Denver School of Medicine. “The actual scientific evidence shows that psychodynamic therapy is highly effective. The benefits are at least as large as those of other psychotherapies, and they last.”

To reach these conclusions, Shedler reviewed eight meta-analyses comprising 160 studies of psychodynamic therapy, plus nine meta-analyses of other psychological treatments and antidepressant medications. Shedler focused on effect size, which measures the amount of change produced by each treatment. An effect size of 0.80 is considered a large effect in psychological and medical research. One major meta-analysis of psychodynamic therapy included 1,431 patients with a range of mental health problems and found an effect size of 0.97 for overall symptom improvement (the therapy was typically once per week and lasted less than a year). The effect size increased by 50 percent, to 1.51, when patients were re-evaluated nine or more months after therapy ended. The effect size for the most widely used antidepressant medications is a more modest 0.31. The findings are published in the February issue of American Psychologist, the flagship journal of the American Psychological Association.

The eight meta-analyses, representing the best available scientific evidence on psychodynamic therapy, all showed substantial treatment benefits, according to Shedler. Effect sizes were impressive even for personality disorders—deeply ingrained maladaptive traits that are notoriously difficult to treat, he said. “The consistent trend toward larger effect sizes at follow-up suggests that psychodynamic psychotherapy sets in motion psychological processes that lead to ongoing change, even after therapy has ended,” Shedler said. “In contrast, the benefits of other ’empirically supported’ therapies tend to diminish over time for the most common conditions, like depression and generalized anxiety.”

“Pharmaceutical companies and health insurance companies have a financial incentive to promote the view that mental suffering can be reduced to lists of symptoms, and that treatment means managing those symptoms and little else. For some specific psychiatric conditions, this makes sense,” he added. “But more often, emotional suffering is woven into the fabric of the person’s life and rooted in relationship patterns, inner contradictions and emotional blind spots. This is what psychodynamic therapy is designed to address.”

Shedler acknowledged that there are many more studies of other psychological treatments (other than psychodynamic), and that the developers of other therapies took the lead in recognizing the importance of rigorous scientific evaluation. “Accountability is crucial,” said Shedler. “But now that research is putting psychodynamic therapy to the test, we are not seeing evidence that the newer therapies are more effective.”

Shedler also noted that existing research does not adequately capture the benefits that psychodynamic therapy aims to achieve. “It is easy to measure change in acute symptoms, harder to measure deeper personality changes. But it can be done.”

The research also suggests that when other psychotherapies are effective, it may be because they include unacknowledged psychodynamic elements. “When you look past therapy ‘brand names’ and look at what the effective therapists are actually doing, it turns out they are doing what psychodynamic therapists have always done—facilitating self-exploration, examining emotional blind spots, understanding relationship patterns.” Four studies of therapy for depression used actual recordings of therapy sessions to study what therapists said and did that was effective or ineffective. The more the therapists acted like psychodynamic therapists, the better the outcome, Shedler said. “This was true regardless of the kind of therapy the therapists believed they were providing.”

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Article: “The Efficacy of Psychodynamic Psychotherapy,” Jonathan K. Shedler, PhD, University of Colorado Denver School of Medicine; American Psychologist, Vol. 65. No.2.

(Full text of the article is available from the APA Public Affairs Office and at http://www.apa.org/pubs/journals/releases/amp-65-2-shedler.pdf )

The American Psychological Association, in Washington, D.C., is the largest scientific and professional organization representing psychology in the United States and is the world’s largest association of psychologists. APA’s membership includes more than 150,000 researchers, educators, clinicians, consultants and students. Through its divisions in 54 subfields of psychology and affiliations with 60 state, territorial and Canadian provincial associations, APA works to advance psychology as a science, as a profession and as a means of promoting health, education and human welfare.

Contact: Pam Willenz
American Psychological Association

202-336-5707

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I was savoring the last bite of my raspberry cheesecake as the lunchtime speaker began. Twenty-five of us from all walks of entrepreneurship were at our local chapter meeting of Women’s Referral Service. We had networked, finished our chicken taco salad and now it was time for the speaker.

044_78016_hToday’s speaker was a financial planner. She was a lovely, soft-spoken, intelligent woman who discussed SEP-IRAs, trusts, annuities and other types of investing. She reminded us how much money we would need in order to retire (“the number.”) She spoke in very simple terms and I learned a lot that day about tracking my income, expenses and investments.

As she ended her talk, she paused dramatically and made eye contact with many of us in the room.

“I know there are a lot of solo-preneurs here – people who have a sole proprietorship company. It can be wonderful and lonely to work by yourself. It is easy to forget that you must work on your business and not just in your business. So make sure you market your business and track your money. Make a profit. Because if you don’t make a profit, then you have a hobby – not a business.”

You could have heard a pin drop. Every single one of us was staring at her and I think some of us had stopped breathing. My business life started to flash before my eyes. My goals were simple: 1) help people 2) pay my bills. That was it. If I did that, I was happy.

You see, having a business was something that I wanted to avoid. I had done the corporate and management thing. I was tired of skirted suits and high heels. I knew I just wanted to have people sit on my couch for 45 minutes while I provided brilliant therapeutic interventions and then they would leave. I did not want the stress and headaches of managing office personnel or other corporate responsibilities.

Then I had another thought. I had no money saved for retirement. I had not taken an actual vacation in six years. When my car needed major repairs, I had to charge them, as I didn’t have any emergency funds. My clothes often came from discount places – and truth be told – sometimes from second-hand shops. I was terrified my computer would have a hard drive crash because – although I had been meaning to – I had not saved a cent for the new one I knew I’d need soon. Somehow I was always surprised when my annual car insurance bill showed up.

Serendipitously, my dad came to visit that weekend. He is a great support of my business venture. He asked, “So, you making any money at this therapist business?”

Good heavens! I had no idea how to answer that question. I had gone over my figures after listening to the financial planner earlier that week and realized I was breaking even – as long as you didn’t count emergency charges on my credit card, no savings, and dining on 99 cent green burritos at the local taco place most nights.

It was time to make a change. The first thing I did was look at my aversion to actually having a business. I was comparing my tiny therapy practice to a billion dollar corporation. It seemed there had been only two options in my mind – breaking even vs. managing a huge corporation with the associate worries about buildings, equipment, customers, suppliers and employees. To think those were the only two options open to a business owner was ridiculous.

I began to design a financial plan for the practice I wanted. Instead of ignoring the fact that I hadn’t taken a vacation, I put the money for one into the budget. I created an “emergency fund” for unexpected expenses such as broken water heaters. An “irregular expense account” was created to save (in advance) for expenses that came throughout the year – for example, malpractice insurance and continuing education classes.

As you can imagine, I needed to bring in more money that I had been earning. Some changes needed to be made in the way I ran my practice in order to have the additional money. In the next two chapters we will talk about how to calculate how much money you need. I call this “The Revenue Assignment.” Then, in future chapters, we will discuss ways that you can bring in that additional money.

In all honesty, it took a couple of years to really get the hang of being on top of my money. I remember one October I made more money than I had made in the prior two months. It was very exciting. I made a huge contribution to my SEP-IRA. I bought a gorgeous designer purse. I all but stopped my marketing efforts as I basked in all that money. November came and went. Then December hit. It seemed every client I had decided to “take a break” during the month of December. I had no money saved for the seasonal lulls in my practice. That became a new category in my financial plan and the next year, I took off three weeks in December. The “December money” was in the bank and I enjoyed my vacation.

But little by little, my income increased and my retirement account grew. Going out for a nice lunch with a girlfriend was a treat – rather than a worry. For the first time in my private practice career, I started to relax. I had a business with a well-planned safety net.

Some of my therapist clients readily admit that they want to do therapy as a hobby. They would like their practice income to compensate them for their practice expenses but these practitioners have no need for their private practice income to pay for any personal or household expenses. Usually these are clinicians who already have a lot of money or they have a family member who is supporting their household expenses. And in the words of Jerry Seinfeld, “Not that there is anything wrong with that.” We all have hobbies and if providing therapy is yours, more power to you! My concern is with the thousands of clinicians who have not felt it was okay to make a profit – the ones who haven’t looked at their numbers out of fear or ignorance and are worrying about the rent payment at the end of every month.  It doesn’t have to be that way. You can learn a few new skills or implement some you already know and start enjoying a lifestyle with less worry and more fun and freedom.

Market your practice on Find-a-Therapist.com

Business Coach  Casey Truffo is a Marriage and Family Therapist in southern California. She identified 8 key strategies that helped her business flourish, and began to help other therapists build their practices. Now she devotes her professional life to helping great clinicians learn what they didn’t learn in graduate school about how to have a fun, fulfilling and profitable private practice. BeAWealthyTherapist.com

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Online counseling or eTherapy is a new way for a client to ’see’ a therapist. Many therapists are finding online therapy is a way of increasing their client “pool” and frees them from the constraints of managed care, freeing them to “do” therapy in the way they prefer.

Online Therapy

Online Therapy

With the Gen X (29-42 year olds) and now Gen Y (18-28 year olds) population of potential clients,  online activities consume more of their daily time, and they are extremely comfortable using technology for all online activities. They are the true online natives and have integrated technology into their everyday lives. They spend more time online than Gen X, watch more online video and text message more often. Technology forms a major part of their entertainment and socializing. “Seeing” a therapist online is a natural and comfortable concept for them.

We personally interview each therapist and require that they provide a sample email session for our review. Additionally, all of our clinicians must have at least 10 years post graduate counseling experience. Ours are the highest standards of any online therapy site on the Web.

Busy schedules, difficulty with traveling to the therapist’s office, fear of going out in public, privacy concerns, and 24 hour availability are only a few of the reasons given for using our e-therapy service.

We offer email, private chat and phone sessions. Online therapy is often a comfortable, convenient way for a client to begin opening up to another person and trying out the idea of therapy, or they may already be familiar with therapy and choose this option for the added convenience and privacy it offers. Many people prefer etherapy to prevent having a mental health record with insurance companies.

Online therapy is not the same as traditional face-to-face psychotherapy. There are some people it will not work as well for. However, there is mounting evidence that it is very effective for some. An Australian researcher, Gavin Andrews, recently published a study that indicates that Internet-based therapies are as successful as face-to-face treatments at combating depression. Here is a link to another recent study with similar findings regarding online therapy and its effectiveness.

Many more people need therapy than those who are already receiving it. In 2005, NPR reported that barely a third of Americans with mental illness get proper treatment. For many the stigma associated with seeking mental health treatment still gets in the way, or trust issues make it difficult to sit with someone in person while revealing personal information. Online therapy can also feel safer or like a good first step for those who feel overwhelmed at the prospect of seeking help and the trust risks involved.

For example, many sexual abuse survivors report that they feel too frightened to see a therapist in person, at least in the initial stages of their healing. It may be much less frightening for them to receive therapy online from the safety and familiarity of their own home.

All of our therapists have passed our thorough screening process, are licensed or certified in their states, and are carefully selected to be part of our network based on their demonstrated professional excellence. Our goal is to provide the consumer of mental health services with another therapy option and to offer only the most expert therapeutic services available online. We offer the following services:

Email Sessions

After purchasing an email session, the client compete a Pre-Session form (intake) which tells you therapist about the clients reasons for seeking therapy. After reviewing the  Pre-Session form the therapist responds by email with a well thought out answer within 2 business days. Our therapists spend approximately 30 minutes on their response. This process is one email session.

With e-mail, much of the benefit for the client is from the writing itself. Therapists often encourage clients to keep journals or write to help clarify and express their thoughts.

A client may have a simple one-time question, or you may choose to use this as a way to establish a longer term relationship with a therapist.

Private Online Chat and Phone Sessions

Telephone and online chat offer additional options from which to choose. For those who have never tried chat, it’s a very simple process. After purchasing a session and completing a Pre-Session form, you meet your client online here, in your “virtual office.” You type a message to your client and he/she responds by typing back immediately, in real time. We provide the secure chat software as part of your Virtual Office. All sessions are scheduled at least 24 hours in advance.  Phone sessions take place by phone and are scheduled at least 24 hours in advance.

We believe the demand for online therapy will increase and since our launch in 2000, we have seen this on our site. In the first quarter of 2009, we saw a dramatic increase in the number of clients, some of which is attributable to the recession, but most because of the convenience it offers.

To learn more or apply to be part of our network, click here: http://www.etherapistsonline.com/therapy/join2.htm

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