Trauma & Attachment Therapy

Research: CBT FAIL!

Huge study in Sweden finds that CBT often doesn't work on anxiety and depression and can make the problems much worse: 

REVOLUTION IN SWEDISH MENTAL HEALTH PRACTICE: THE COGNITIVE BEHAVIORAL THERAPY MONOPOLY GIVES WAY

Please don't flame me, I'm just reporting the study.

Trauma Treatment Handbook: Protocols Across the Spectrum

My copy of the new book arrived today. Here is what Diana Fosha says about it:

"This is a thorough, accessible, and very practical book, filled with resources and sound ideas, filtered through the intelligence and experience of a savvy, compassionate, down-to-earth, and very experienced clinician. It is like a travel guide to the land of trauma and trauma treatment: if you are new to it, it will orient you to all there is to do and see; if you're a frequent traveler, it is a worthwhile reminder of all that is out there, above and beyond the familiar places you always visit. Once could ask for a better guide. I highly recommend it."

I explain trauma, complex trauma, dissociation and how to assess them and prepare for treatment, and all the kinds of treatment that I know about from the main-stream to the obscure. I talk about working with military, sexually-abused, and relationally traumatized people, and how to take care of yourself while doing the work.

 Some of my heroes comment on it. Dan Siegel wrote the introduction, despite my lack of research. Diana Fosha, Stephen Porges, Kathy Steele, and Onno van der Hart wrote very nice blurbs on the back. I'm humbled by their support.

This is the first book written completely by me. I'm amazed to be responsible for synthesizing so many people's therapies in one book. The design is great, and the photos, by Doug Plummer (my beloved) are gorgeous.

Ethics and Technology Workshop

I attended Lisa Erickson's Professional Ethics & Technology workshop today, sponsored by Cascadia Training. Here's what I came away with:

SKYPE

Skype, the computer phone and video-phone service, is encrypted and hard to break into. If Skype's employees wanted to listen in, they could. But why would they?

The picture can freeze, fragment, or lag. You can't do eye contact. And it's still often better than the phone because you can see each other.

If you are "skyping" or emailing a session, have a back-up plan in place (like the phone) in case the technology fails.

Many of us in the workshop wouldn't use Skype for regular sessions, but would use it for sessions if the client or therapist was out of town. Some do and many would use it for consultation or supervision.

You can only legally do long distance psychotherapy if the client resides in a state in which the therapist is licensed.

Informed Consent

Add a new section to your consent form stating your rules about technology. For instance:

• I never "friend" anyone who is or has been a client of mine.
• Email is not 100% secure. Email security can be breached. My email policy is this: Either: "I don't do it with clients." OR "You may email me only for changes of appointment." OR "You may send me emails to update me on your status, but I don't return them." OR "I will try to respond within 24 hours, but if I don't, please call me on the phone, because I may not have gotten the email." And/OR "I will charge $2 per minute for reading and responding to any email longer than one brief paragraph." (With some clients who seem to want to move the therapy to email, I stop accepting emails except for appointment changes.)
• "Please do not send me emails, or Skype me from any place that is not secure and private, including the library, an internet cafe, your job, or any public network or place. I don't want your confidentiality breached."
• "If you want to show me something on Facebook or your blog or any other social media, you can show me during our session from your account or print it out for me. I want to be sure to protect your privacy, even from me."
• "I don't google my clients, so if you want me to know something, tell me."
• "Since we live in different areas and do therapy through the computer, I will provide you with a list of emergency services available in your area."
• Conversations by cell phone or cordless phones may be picked up by people in the area. The only completely safe phone call is from one old-fashioned corded phone to another. When we have a phone call, be sure that you can't be overheard.

Other random issues

• Online or phone sessions are not covered in 39 states. Telemedicine is covered in the other 11, and it's unclear if therapy is "medicine" in all of them.
• On your website, provide links to relevant state licensing boards to protect your clients' rights.
• Make sure you do online work with people who have the equipment, technical savvy,  access, and ego strength to do it well.

Resources

(a few of the many that Lisa Erickson gave us)

M. Maheu has a great technology/therapy blog: http://telehealth.net/blog/ 

Mahue, Pulier, Wilhelm, McMenamin, & Brown-Connolly (2005) The Mental Health Professional and the New Technologies

metanayoia.org: Safeguarding Patient Confidentiality in email.