http://www.thestranger.com/seattle/SavageLove?oid=15567539 Comments On: Savage Love by Dan Savage en-us Copyright 2013 The Stranger. All rights reserved. This RSS file is offered to individuals, The Stranger readers, and non-commercial organizations only. Any commercial websites wishing to use this RSS file, please contact The Stranger. webmaster@thestranger.com (The Stranger Webmaster) Fri, 24 May 2013 00:00:01 -0700 Fri, 24 May 2013 23:45:00 -0700 Foundation http://blogs.law.harvard.edu/tech/rss sohbet ,
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Posted by hereticko]]> Wed, 03 Apr 2013 19:25:40 -0700 The Stranger Posted by Ninalyn]]> Tue, 25 Dec 2012 23:41:45 -0800 The Stranger
Posted by Hunter78]]> Mon, 24 Dec 2012 15:01:29 -0800 The Stranger Posted by Eirene]]> Sun, 23 Dec 2012 13:44:39 -0800 The Stranger
It was a German newspaper article (pop science, not original research) so there is no point in linking it directly.

But among others, they cited this study:
http://onlinelibrary.wiley.com/doi/10.10…

This might be connected:
http://psychcentral.com/blog/archives/20…

And they referred to a, as-yet unpublished, study by Nestoriuc from Vienna university about the factors leading to side-effects of psychotherapy.
Posted by migrationist]]> Sun, 23 Dec 2012 12:26:38 -0800 The Stranger Posted by mydriasis]]> Sun, 23 Dec 2012 10:55:14 -0800 The Stranger and his elves. His two fully grown-up elves.

One the color of caramel, his touch nervous and light in turns, his body as smooth as satin. And one as big as a bear and wholy covered in luscious fur, soft spoken and gentle.

Oooh Mommy loves Christmas...
Posted by sissoucat]]> Sun, 23 Dec 2012 10:30:44 -0800 The Stranger
Posted by Hunter78]]> Sun, 23 Dec 2012 05:13:44 -0800 The Stranger Posted by sohbetodalari]]> Sat, 22 Dec 2012 15:47:22 -0800 The Stranger Posted by EastCoastDude]]> Sat, 22 Dec 2012 07:21:55 -0800 The Stranger
Bipolar, schizoid disorders and psychosis tend to show up (diagnosed anyway) in your early-mid twenties, so late 30's is pretty late.

And those problems actually are some of the ones we have the most effective treatments for. You can medicate for this stuff, and it makes a huge difference. Therapy too, of course, you need help to navigate the disease, but man, on meds off meds is like night and day. You can look at someone and know if they've been taking them correctly. It's like a miracle when they get them (more or less) right.

And the earlier you treat, the less severe they tend to get. So best figure out how to identify it faster, including in kids, if it can be.

Anyway, that's kind of off topic to the original letters. I think therapy does have some use for this girl if she chooses it, because here's what therapists do - they offer you perspective, are neutral, don't judge, you don't have to spare their emotions like you would a friend, they are completely confidential and you can talk to them knowing that they will never tell a soul and you don't have to see them in your everyday life, they offer a sounding board for your problems and help alleviate self-hatred by helping you work toward some sort of clarity. Therapy is a tool, and it can be useful if you want it to be. Can be lifesaving too, and certainly helps drive through pain faster than working on things alone. It's good to talk to someone with some experience with these things, right?
Posted by gnot]]> Sat, 22 Dec 2012 03:07:10 -0800 The Stranger Posted by sissoucat]]> Sat, 22 Dec 2012 02:56:18 -0800 The Stranger Posted by lolorhone]]> Sat, 22 Dec 2012 00:29:50 -0800 The Stranger
Wow, that's awful. Therapy should always be confidential, I can't imagine the use of an age limit.

@Kate

I agree. I also think that faking/manipulating is more common for people in court-ordered, school-orderered or otherwise punitive therapy. I don't believe in forcing people (even children) into therapy. The point is identifying the problem, and offering the opportunity to work on it. People who are willingly in therapy are unlikely to intentionally manipulate their therapists.
Posted by mydriasis]]> Fri, 21 Dec 2012 18:16:14 -0800 The Stranger
Could you link up that study please?

I think that seandr answered your question better then?

Seandr - I agree. I typically see medication as a push for people who can't manage therapy yet.
Posted by mydriasis]]> Fri, 21 Dec 2012 18:12:57 -0800 The Stranger Posted by Wendym]]> Fri, 21 Dec 2012 10:58:24 -0800 The Stranger
There is absolutely a chance that some people will work the system to get what they wanted out of it. I have been guilty of that myself when it comes to mental health treatment in the past. However, I think if the stigma were removed, it would happen less often. Mental health treatment (in America anyway) can be expensive, besides being looked down on. Making it not only more accessible, but a requirement, would mean that you wouldn't be singled out for seeing a therapist, it would be normal. Some people would still work the system, but overall, people would be less inclined too, IMO.
Posted by KateRose]]> Fri, 21 Dec 2012 10:15:17 -0800 The Stranger
Great! In msg 72 your priestess saved your relationship with your wife; in 74 she saved your relationship with your husband. She's a real miracle worker.


Posted by Hunter78]]> Fri, 21 Dec 2012 09:49:00 -0800 The Stranger
There is nothing I disagree with in your post. But I think you missed my point.

All I wanted to point out was that it seems more difficult to design a good rigorous study to compare different approaches to psychotherapy than for different kinds of drugs. And funny that you should mention lack of side-effects as the advantage of psychotherapy. There's just been an article about the outcomes of psychotherapy and its side-effects, and that negative side-effects are more common than expected. In Austria university researchers apparently have developed a list of risks and side-effects of psychotherapy for patients.
Posted by migrationist]]> Fri, 21 Dec 2012 09:42:37 -0800 The Stranger There seems also to be a lack of evidence which kinds of psychotherapy work and to what degree and for which population groups.

Not at all. Pick any common mental affliction, and you'll find scores of treatment outcome studies along with meta-analyses that rank the effectiveness of various approaches. The best approach usually depends on the affliction (DBT for borderlines, Maudsley for anorexia, cognitive behavioral for phobias, etc.)

No, they aren't double-blind, but when you're dealing with a program that operates through the recipient's conscious mental processes, they can't be, nor should they be - the point of blindness in drug studies is to filter out the influence of psychological processes, whereas with therapy, those processes are largely the point. This is the same for outcome studies of, say, educational programs (e.g., math curricula, charter schools vs public).

As for lack of a placebo control group, if a study compares 2 or more different therapeutic methods, it can still isolate some of a given method's contribution beyond the simple act of showing up and having a chat. FWIW, my disdain for psychoanalysis is based in part on my familiarity with some of these types of studies.

That said, a lot of people seek help for problems that manifest as depression or dissatisfaction but are caused by some combination of that patient's personality, history, and the particular set of circumstances they find themselves in (e.g., relationship, career). In those cases, anti-depressants can provide symptom relief, usually at the cost of some unfortunate side effects, but they don't necessarily target the dynamics responsible for the problem. In my experience, they simply can't compete with an effective therapist who is able to figure the particular puzzle you present to them.
Posted by seandr]]> Fri, 21 Dec 2012 09:34:17 -0800 The Stranger
There were a few things about your post that threw me, but I'll start with the age thing since I'm pressed for time.

What about depression

The average age of onset is getting lower. As it currently stands, age 15-24 has the highest rate of depression and I would not be the least bit surprised to see subclinical/mild depression in those 13 year olds who will have depression later in life.

"Depressive symptoms that don't quite meet the diagnostic criteria for major depression are even more common in adolescents. A study of 9863 students in grades 6, 8, and 10 in the United States found that 25% of the girls vs. 10% of teh boys reported elevated depressive symptoms."

or substance abuse

Substance abuse is certainly not unheard of in middle school, and most hardcore drug addicts start early. But in any case, substance abuse is virtually always a comorbid condition with another disorder and I think it's disingenious to treat it in a vacuum.

or PTSD?

Um, look above - there's lots of PTSD in children. Childhood abuse is a massive cause of PTSD. And PTSD in adults who have experienced massive trauma is a miraculously low-stigma disorder, so it's low on my concern list in this context.

I'm thinking of a friend who had his first major psychotic episode with bi-polar when he was in his late 30s.

That's an argument for early screening, not against it. There's a big difference between the onset of a disease and the first major psychotic (manic?) episode of the disease. So in other words, with screening they get offered help at the former, without screening they don't look for help until the latter.

We're currently more likely to recognize bipolar in teenagers and young adults (typical onset) but again, there are people trying to pioneer ways to catch it earlier.
Posted by mydriasis]]> Fri, 21 Dec 2012 08:58:39 -0800 The Stranger Some mental health problems are so severe that no amount of help is going to keep a person from doing something to harm themselves or others, but most people have a chance to, maybe not get better, but maintain a normal life.
Posted by KateRose]]> Fri, 21 Dec 2012 08:06:13 -0800 The Stranger
That said, I believe there is more mystery to what psychotherapists do. You kind of wonder if the information couldn't be gotten more cheaply from a book, or you wonder if sympathy is for sale.

69- Pretty much every psych disorder besides schizophrenia shows up before age 13? What about depression or substance abuse or PTSD? I'm thinking of a friend who had his first major psychotic episode with bi-polar when he was in his late 30s.

But more than that, the problem with psychiatric screenings is that I'm afraid people would learn the right things to say to get the results they want. You find that in drug treatment programs. They work wonders for some number of people who want help getting sober, but for others, they learn the party line, the script, and then go on to give a great performance on following the 12 steps when they're still getting drunk on non-meeting time. If someone knows that there's a likelihood that they'll be committed to a mental institution if they don't straighten up, they're probably not going to think that there's this nice place where they're going to get the help the need. They'll more likely think that they better show all the signs of conforming.

So while I certainly agree that it makes sense to remove the stigma on mental illness and make it easy for people to get treatment, I see practical barriers until the treatments get better. Right now, even with the best efforts, we don't really have something that works for bi-polar or schizophrenia or for psychopaths. It's a puzzle.
Posted by Crinoline]]> Fri, 21 Dec 2012 08:02:04 -0800 The Stranger
You ever watch Scrubs? I'm picturing Dr. Cox's therapist as the quintessential "male" therapist. :p

@Kate

I'm a big believer that people should have mental health 'checkups' just like healthy people have physicals once a year. I also think that sometime in junior high (hey we could get rid of all the anti-drug stuff and then we'd have the space) they should have someone come into schools and talk to each of the students. Obviously it wouldn't be perfect but just to identify if anyone is in need of psych help. Pretty much every mental disorder shows up by 13 (except schizophrenia, off the top of my head) so I think it'd be the ideal time to screen.

Of course it would never happen but it's my dream. I'd also love it if they could spend some time breaking down misconceptions about mental health, teaching kids to not stigmatize eachother.

I could go on, but I'll spare you.
Posted by mydriasis]]> Fri, 21 Dec 2012 07:19:01 -0800 The Stranger
Comparing drugs and therapy is, in some ways, like comparing apples and oranges.

I'll start off by saying that I'm not anti-medication (lest we forget my lengthy and heavily contested defense of psychiatric medications a few weeks back or whenever that was).

But therapy holds the benefit of not increasing suicidal ideation. Therapy also doesn't cause such intense nausea that the patient has to take a week off work or out of school. Therapy doesn't increase your risk of diabetes. Therapy is pretty unlikely to cause erectile dysfunction. You can't take all your therapy sessions at once in an attempt to kill yourself. In fact, therapy poses virtually no risk to your health at all.

Anyway, to my knowledge there is a fair bit of evidence for which kinds of psychotherapy work in which population groups (by disorder, not gender, though) - I just personally think that there's enough individual variation within those groups to muddy the waters somewhat.

How do you define a success?

Um. I'd imagine the exact same way you would for medication? The symptoms improve?

What is a reasonable time until you should see the positive outcome?

Who's "you"? In this equation? The patient? In my experience, people often make progress and improve in ways that are perceptible to others (the therapist, friends) but that they don't realize yet. Depressed people especially are not especially sensitive to positive trends in their lives so it might take a while for the message to sink in. Different kinds of therapy suggest different time lines. CBT often gives a 6 month timeline from what I've seen.

But improvement isn't binary. The longer a person dedicates, the more they will improve, in different amounts, at different times, in different ways. Maybe a little jump in functioning at six months. Maybe a jump in mood at 11 months, etc.
Posted by mydriasis]]> Fri, 21 Dec 2012 07:07:31 -0800 The Stranger