Monthly Archives: February 2007

Psychological torture on trial

Following on from my earlier post about the involvement of psychologists in torture at the Guantanamo detention facility, it has been interesting to read several recent commentaries in the Guardian about this issue:

1] Naomi Klein writes about a current trial in the US that may serve to expose to judicial review the use of psychological methods of torture on detainees (see link here). This has come about because a US citizen has allegedly been exposed to torture during his imprisonment and now his case has come to trial (due to the suspension of habeas corpus, foreign detainees at Guantanamo and other facilities who experience torture cannot appeal to judicial review).

2] Peter Kinderman, professor of clinical psychology at the University of Liverpool, writes about the limited outcry from mental health professionals and their organisations to the reports of psychological methods of torture on detainees.

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Filed under Clinical Psychology, Mental Health, Politics, Psychology

Using virtual reality to treat PTSD

Of interest this week are reports of an innovative exposure-based treatment of post-traumatic stress disorder using virtual reality. The Guardian describes the work of Professor Skip Rizzo at the University of Southern California in Los Angeles in developing a “virtual Iraq” simulation to assist treatment of soldiers experiencing PTSD. This simulation involves exposure to visual, auditory, tactile, and olfactory stimuli associated with combat scenes in Iraq, with the therapist being able to control the level of exposure through a computer interface. There is a further description of the project here and some video examples of the virtual reality program with this coverage from NPR.

A core component of a cognitive behavioural therapy approach to treating trauma is graduated exposure to stimuli associated with traumatic memories. This can involve actual or imaginal exposure; with virtual reality there could be a “third option” in terms of exposure, especially if the stimuli are difficult to physically access (such as low-level combat scenes).

So far these are initial reports of the treatment approach using virtual reality, with descriptions of benefits for some of the participants. It will be interesting to hear about the results of any controlled research that follows on from this.

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Filed under CBT, Clinical Psychology, cognitive behavioural therapy, Mental Health, Psychology

Classic cinema @ the Action Écoles: 23 rue des Écoles, Paris

I have visited Paris a bunch of times since living in Europe, and as a love-struck tourist I can’t get enough. Aside from the culture, food, fashion, beautiful streets, reasurringly rude waiters etc., Paris is also a cinephiles dream.Action Ecoles cinema

I spend a fair amount of my time in Paris going to the cinema, as it is a brilliant place to see classic films. A suitable tonic to the multiplex, with its popcorn-munching patrons, there are a number of dedicated cinemas to the art-form dotted around the city (particularly on the Left Bank).

My favourite cinema to visit is the Action Écoles on 23 rue des Écoles, with two screening rooms and a penchant for showing American films from the 40s through to the early 80s. There are no advance tickets, you just queue outside and hope to get in (Five minutes before the tickets sell a crowd appears from nowhere).

A list of the films I have seen there over the past 7 years should give you a good idea of the quality at the Action Écoles: Casablanca; Everything You Always Wanted to Know About Sex (But were afraid to Ask) ; Rosemary’s Baby; The Outsiders; Stand By Me; Notorious; To Catch a Thief; Lolita; Dr Strangelove; Love and Death; and Mr Smith Goes to Washington.

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Filed under Cinema, Places, Travel

Finally “Dr” Gillian McKeith is taken to task

Good news this week as TV diet guru Gillian McKeith agrees to drop the title “Dr” from the marketing of her products after the Advertising Standards Authority came to the provisional conclusion that her use of the title (based on earning a PhD from a non-accredited distance learning college) was likely to mislead the public (see article here).

Perhaps the use of the honorific is not the only thing “likely to mislead the public”. McKeith’s apparent understanding of biology and approach to nutrition has been labelled as pseudoscience by a number of nutritional experts (for an example, see here). This has been well-documented by Ben Goldacre, writer of the Bad Science column in the Guardian, who outlines the various erroneous claims and shaky evidence behind McKeith’s methods (see link here).

Of course, this may not necessarily put a stop to McKeith’s brand of pseudoscience. She happens to be the star of a popular show that has all the elements of reality TV gold: a steady succession of participants that audiences can look down on, the use of ritual humiliation, a cynical view of human nature, and a story arc of redemption/behaviour change, produced through a hectoring style of communication. Pure”entertainment”.

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Filed under Pseudoscience, Television, United Kingdom

There’s no such thing as a free lunch with drug reps

In the time that I have spent working in mental health services it has been hard not to notice the effects of drug company marketing, and in particular marketing to non-prescribing professionals, such as mental health workers and psychologists.

Drug reps regularly contact managers of community mental health teams and offer to provide free lunches, pens, coffee cups, post-it notes, etc. so that they can have the opportunity to talk about their products. This hospitality can extend to providing a bar tab for a team to go out to the pub, or sponsoring Christmas dinner. In some settings it is difficult to find stationery that is not branded with logos from drug companies. All of this marketing is designed to increase prescribing for the company’s product, and my guess is that marketing to non-prescribers has that effect.

At present, in the cash-strapped NHS, pragmatism by clinicians can provide opportunities for marketing by pharmaeutical companies. A regular concern in my service is about how we can get the funds to print pamphlets and other educational material that we have written to cater for the needs of local people. We have no money to do this within our budget – but we know some drug reps who may gladly help us to professionally print our material, while having their company logo displayed somewhere on the pamphlet. It can be a difficult choice to decide to take pharmaceutical money for this, particularly if the pamphlet is focused on a psychological approach to understanding a mental health problem.

My concern with the effect of drug company marketing is the pernicious influence of reductionist biological models of human distress: psychosis simply becomes a problem with dopamine, with social and psychological influences on mental distress airbrushed out of the picture.

This marketing can directly influence the activities of psychologists: I can remember working in Western Australia when a pharmaceutical company sought to ally itself with the brand of “cognitive behavioural therapy” in the treatment of social phobia. It did this by supporting the activities of psychological therapists: being a sponsor for a local training event for CBT for social phobia, providing the gift of a gold-standard text in treatment approaches for anxiety disorders, and sponsoring the publication of psychoeducational material for therapists to use in several local clinics. It just so happened that this pharmaeutical company had a product newly licensed for the treatment of social phobia, and it seemed a shrewd move to link their product with the gold-standard (but non-drug) treatment.

Some clinicians and healthcare organisations have decided to limit the influence of pharmaceutical marketing in their practice: those readers who are interested should check out the No Free Lunch campaign at this link. There is also a UK version that is delightfully lo-fi (in that British kind of way), it is here.

Quixotic perhaps, there is also a nice article about drugs reps and clinical psychology here.

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Filed under Clinical Psychology, Mental Health

Writing therapeutic letters

Lately in my clinical psychology work I have been writing an increased number of therapeutic letters to my clients (“therapeutic letters” are not in a report format but more like a personal letter, and part of the process of therapy, such as a description of a case formulation or a summary of the work we have been doing).

I think the main reason for this change in my behaviour is that a number of the clients I work with experience problems with memory and attention during recovery from psychotic episodes and so report having trouble remembering what we discuss in the sessions. From my end I have thought that it has been useful to provide a summary, with more detail than the couple of bullet-points that we usually come up with at the end of the session.

Writing a therapeutic letter has got me thinking about the style of letter writing, and how to convey a compassionate, validating stance while also describing my conceptualisation of what is going on for the client, and what I think might help. It provides a challenge to convey psychological concepts in manner that makes sense, is caring, and may move things forward for the client. Letter writing also feels a more linear activity than a conversation in a session, which allows for dialogue, questions and clarification. It is harder to judge how the message is coming across, compared to meeting the client and observing body language. Letter writing has a delayed feedback quality while also having more of a permanence than conversation in the therapy room. It can invite perfectionism, as I try to find the right words and think about how this letter may be something more lasting that the client may refer to. I occasionally have an image of the client reading the letter years later, and that sense of posterity can be a bit intimidating as a writer (for me at least).

I know my colleagues who use a cognitive analytic therapy approach put a lot of stock into letter writing as one of the central interventions. Also Paul Chadwick has recently described the use of letter writing in working with psychosis in his excellent book, “Person Based CognitiveTherapy for Distressing Psychosis“.

There have been broader changes within the NHS in policies concerning copying letters to patients, so that there is greater transparency in what health professionals communicate about a patient’s healthcare. I think it could mean that professionals write letters about the details of patients lives in a more compassionate way and the idea of a dialogue between patient and professional is built-in.

The act of writing can, of course, clarify things in my own mind about the approach we are taking. I have also found my own sense of compassion for clients increases by writing; it is helped at times when I have felt “cut-off” or blaisé about my client’s problems. Like good journaling, the meditation of writing a therapeutic letter allows for sustained exposure to my own thoughts and feelings about what it is happening in the therapy room.

And it isn’t one way traffic either: the other day I received a reply letter from a client about her view of the unusual experiences she has been having and what she thought was important to focus on in therapy. This was really valuable to me as this client has tended not to assert herself in the session and it has been hard to judge my efforts so far. The letter both reassured and challenged me: the benefits of a good dialogue.

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Filed under CBT, Clinical Psychology, cognitive behavioural therapy, Psychology