Oliver James Rubbishes CBT and Happiness

Submitted by tonyplant on October 24, 2006 - 16:37.

I like the work of Oliver James: he is an interesting speaker and an engaging writer. I've been aware for some time that he is not in favour of Layard's enthusiasm for cognitive-behavioural therapy (CBT) and he usually makes his viewpoint in a cogent manner.

Not today. Today, Oliver James has contributed a piece to the Daily Mail: Therapy on the NHS? What a crazy waste of £600 million! He starts off with the headline figure that depression and anxiety cost the £17 billion per year and then moves on to deride Layard's proposed £600 million investment in expanding the provision of CBT on the NHS.

It's an infuriating piece. James makes several sideswipes about the efficacy of CBT.

CBT is a form of mental hygiene. However filthy the kitchen floor of your mind, CBT soon covers it with a thin veneer of positive polish. But shiny surfaces tend not to last.

According to James

The CBT patient is taught a story to tell themselves, a relentlessly positive one. If the therapist is skilled, the patient becomes able to ignore many of their true feelings.

When tested at the end of the treatment, like a well-coached pupil taking an exam, they often regurgitate the positive story.

I thought that one aspect of CBT might be the examination of whether negative thoughts and feelings are grounded in unrealistic beliefs. Is it possible that these negative thoughts and feelings are false rather than true?

read more | 3 comments | Layard | happiness | depression | CBT | anxiety

Communication, explanation and understanding

Submitted by tonyplant on April 17, 2006 - 15:02.

Judges in the US are attending a programme of classes to educate them in the science and medicine that underlies the detection, diagnosis, treatment and prognosis of disease. The programme is intended to help in the ajudication of medical malpractice cases.

In addition to acquiring a scientific knowledge base, judges said they learned that understanding physician-patient communication is key to interpreting complex medical cases.

Ohio trial Judge Lee Sinclair said he was particularly enlightened by a mock exercise in which a newly diagnosed cancer patient evaluated treatment options with several doctors, including a surgeon and an oncologist.

When the judges got together to discuss the conversation, “what you realized was everyone in the room heard things in a different way,” Sinclair said. “Often what you hear in medical malpractice cases is the physician saying he explained it to the patient and the patient saying it never happened.”

The insights are especially valuable in helping judges eliminate potentially frivolous lawsuits or find alternate ways to resolve legal disputes without going to trial, said Marvin J. Garvis, a Maryland federal judge.

I found this exercise interesting for a number of reasons. How many times have we heard someone say, "But I told you that", or "You never told me about that". Sometimes, we have been told information but the stress or shock of the circumstances under which we were told means that we don't remember. Sometimes, we retain fragments of the information, rather than its context.

read more | add new comment | gladwell | explanation | communication | cognitive behavioural therapy | charles tilly | CBT

What Is The Cost Of Doing Nothing?

Submitted by tonyplant on April 12, 2006 - 16:52.

Malcolm Gladwell has an extraordinary piece entitled Million Dollar Murray: Why problems like homelessness may be easier to solve than to manage. In a lengthy and fascinating read he effectively challenges some of my previous thinking about homelessness as a wicked problem causing honest paralysis over difficult issues. Wicked problems arose in the area of public policy and are described as "a set of problems that cannot be resolved with traditional analytical approaches". It is the nature of wicked problems that unanswered questions and chronic issues can take years to work out or never be satisfactorily resolved.

Two police officers in L.A. made an informal calculation as to the costs of managing "chronically homeless inebriates" like Murray Barr whom they had cared for over many years.

...Johns and O'Bryan realized that if you totted up all his hospital bills for the ten years that he had been on the streets—as well as substance-abuse-treatment costs, doctors' fees, and other expenses—Murray Barr probably ran up a medical bill as large as anyone in the state of Nevada.

"It cost us one million dollars not to do something about Murray," O'Bryan said.

Gladwell discusses the research into homelessness by Dennis Culhane.

What he discovered profoundly changed the way homelessness is understood. Homelessness doesn't have a normal distribution, it turned out. It has a power-law distribution. "We found that eighty per cent of the homeless were in and out really quickly," he said. "In Philadelphia, the most common length of time that someone is homeless is one day. And the second most common length is two days. And they never come back...

...The next ten per cent were what Culhane calls episodic users. They would come for three weeks at a time, and return periodically, particularly in the winter. They were quite young, and they were often heavy drug users. It was the last ten per cent—the group at the farthest edge of the curve—that interested Culhane the most. They were the chronically homeless, who lived in the shelters, sometimes for years at a time. They were older. Many were mentally ill or physically disabled, and when we think about homelessness as a social problem—the people sleeping on the sidewalk, aggressively panhandling, lying drunk in doorways, huddled on subway grates and under bridges—it's this group that we have in mind.

Culhane discovered that about despite the size of the homeless population in New York, there are 'only' 2500 who are chronically homeless. Culhane's most startling finding was that New York spent sixty-two million dollars p.a. to shelter just those 2500 hard-core homeless. Studies in both Boston and San Diego reported extraordinary levels of medical and social care spending on similar high-need populations that confirmed the calculations made by Johns and O'Bryan in L.A..

1 attachment | read more | add new comment | moral intuition | homeless | gladwell | fallacy of fairness | CBT | carers | caregiver | alcoholism

BACP On Disagreeing With Layard's Proposals

Submitted by tonyplant on February 12, 2006 - 18:03.

A while ago the British Association for Counselling and Psychotherapy issued a press release that criticised some of the Layard proposals: specifically those calling for the training of more therapists (BACP argues that a sufficient number already exist), and those that emphasis the importance of the cognitive behavioural therapy approach above other strategies.

Economists argue that anxiety and depression are a burden on the economy. Mental Health specialists (among others) counter that they are an unaffordable burden on society. Layard says that happiness should be seen as more than a health issue. The BACP unhelpfully offers the counter-claim that

Unhappiness is the consequence of more than a diagnosed condition and always arises from a life situation.

And they offer counselling etc. as part of the solution. Which still looks like medicalisation of a psychosocial issue to me. I will put more about this in another post.

 

Copyright 2006, Tony Plant Happystance Project

add new comment | unhappiness | Layard | happiness | depression | cognitive behavioural therapy | CBT