Tag: psychotherapy

Another Crappy Day

by Midnight Demon, posted in Chronic pain, mood disorders, psychache, suicide

I have been in a depressive funk for the past few days. It started with a CES accident and has not let up since. Most days I do not think I have CES because my symptoms are minor and the burning in my legs have dwindled for the past week for some reason, maybe because I have gone back on my mood stabilizer. Well the mood stabilizer has done nothing to stabilize my mood. I have gone off the deep end twice and have thought nothing of killing myself for no good reason. Anything that doesn’t go my way I am thinking of ending my life.

It started before New Years so I can’t say with certainty the holidays brought it on. Now I am dealing with voices. They are a low mumble right now. I hate them more than I hate being suicidally depressed. I think I might end up in the hospital if I can’t get the voices under control. I kind of stopped my meds last week because I was getting horrible side effects. Now I am back on them but it is going to take a couple days to work up to a therapeutic dose.

I had to reblog one of my blogs because it got spammed really bad. I was getting spam messages almost every day that had nothing to do with the content of what I was saying. It was depressing because it is a paper I worked hard on for the past few years. I know the blog world doesn’t think much about academic papers but I know I couldn’t get this published anywhere so a friend said to blog it. I have gotten good reviews from friends about it. I have gotten nothing since the reblog.
Yesterday I had 50 viewers on my site. Not bad as my average is usually 17-20 but no one left me any comments…

Yesterday I went out to read and lost the book I was reading. It fell out of my bag and left me really depressed. It is a book about suicide and I was getting to the “good” part of what the underlying cause of my suicidality is. I feel like such an idiot for losing it (I forgot to close my bag after putting it back in). I suppose I could go to the bus stop tomorrow and see if anyone has turned it in. Most likely someone just threw it away. The thing that really stinks is that it is an autographed copy. I got the book when the American Association of Suicidology was in Boston for their annual conference. I have ordered another copy on Amazon but it is a paperback and I had the hardcover. I like hardcovers better than paperbacks. It is so depressing.

I must have thought a million times to page my psychiatrist or my therapist because my mood has dropped twenty degrees in the past 48 hours. I just don’t know what to do. I know part of it is because I still have my menses which I shouldn’t have. It is messing me up with the whole transgender thing. I am a male and should not be getting menses. I am in the wrong body. I am so upset I have thought about cutting to soothe myself but I don’t want anyone to see my scars. I have little ones that will harp on it like a bat out of hell. And I don’t want to worry my family so I suffer. It’s not like talking about it is going to help anyways.

how to save a life paper

by Midnight Demon, posted in depression, mood disorders, suicide, suicide attempt

Music is an important part of the human race. Each individual has his/her own genre they prefer. Music can help heal a broken heart, discharge stress and to relax while going to sleep.
Often times music’s lyrics can hold a very powerful message. That is my goal with this essay to write about the song, “how to save a life” (The Fray, 2005). By using personal and clinical information, I hope to inform the mental health professionals about how to save a life when a client is thinking about suicide and what it means to get help from a mental health professional. This paper is written from the view point of a clinician and a patient who is engaged in therapy.
Jobes, Moore, and O’Connor (2007) have stated that assessing a patient’s suicide risk at each medical office visit as collecting vital signs. Quinnett (1987) has stated that there is only a ten minute window of when a person thinking of suicide will actually go through with it. It is extending those minutes that is an important step to prevent a suicide.
Sometimes there are signs indicating suicidal thinking such as, giving away of possessions, saying things will be better if I just “go away”. Sometimes these signs are not so subtle. In the wake of a completed suicide, one often wonders, “what they could have done differently”.
The rock band, The Fray, has written a song called, “how to save a life”(Slade, 2005). I would like to express in this essay, how important these lyrics are to help save a life, whether it is someone else’s or your own.

“Step one you say we need to talk
He walks you say sit down it’s just a talk
He smiles politely back at you
You stare politely right on through
Some sort of window to your right
As he goes left and you stay right
Between the lines of fear and blame
You begin to wonder why you came”

These opening lines talk about the initial conversation when the person who is having suicidal thoughts is being confronted. This is a crucial conversation as it allows you to assess what the person is thinking and to let them know you are concerned. The lyrics could also be viewed as the initial consultation a clinician has with his or her client, whether it was initiated by a friend, significant other, or family member. Family and/or friends are hoping that this person, who means so much to them, can open up to this person (therapist, minister, or counselor) to get the help that they (friend or family member) cannot offer or give. This is not to say that the friend or family has rejected the individual in his or her distress. The distressed individual may just need an unbiased, neutral person to talk openly about how they are feeling and what has brought them to the verge of suicide. Life for this person at this point is bleak, hopeless and unworthiness has invaded their soul. The individual feels he or she cannot confide in others. He or she feel they are a burden to friends and family members and have begun to shut himself off from those that love them. He sees only one option left to them: suicide. This is very dangerous thinking. The four letter word “only” is very significant and carries a lot of weight. Dr. Edwin Shneidman spent his career in working in the field of suicidality and forming the foundation for suicidologists in the United States. According to him, this word is the most “dangerous” word to be spoken by a suicidal person (E. Shneidman, 1985).
As long as there is human life, the threat of suicide is always going to be an issue. It is an indiscriminate symptom of mental illness, such as bipolar depression, major depression or schizophrenia. Some times suicide is not related to mental illness at all. It could be a response to a crisis that seems to have no end. Whatever the reason, “suicide will be a permanent solution to a temporary problem” (Quinnett, 1987).
Some experts will say that suicide is preventable, others believe that it is treatable. I say that it is manageable. When suicide becomes the only option, the question becomes what to do with this suicidal thinking: if the individual reaches out, they may go to a friend or family member for help or suffer along and pray his distress will end.
Most clinicians do not know much about suicide. Each clinician has their way of dealing with it or perhaps, not dealing with it at all. Some will refer their client to another clinician the moment suicidal thinking is mentioned. Most almost always use what is known as a safety contract: essentially an agreement, written, verbal, or both, saying that the client will not harm or kill himself or herself in any way until the next session with the therapist. If the client does not agree to this, the option is that the client will be hospitalized, often against involuntarily. If the clinician fails to hospitalize a client that is in danger of hurting themselves and the client dies, the clinician is subject to malpractice and potentially the loss of the licensure. In Rudd’s article (2006) 41% of clients under contract died by suicide or made a serious suicide attempt. These contracts have no legal standing but are used from a medicolegal point of view. To ensure the liability of the clinician, the client is placed in the hospital. In my opinion, this is the clinician’s get of jail free card and the jail term of the client. The lyrics: “Let him know that you know best/Cause after all you do know best” best describe this situation.
Is there a better way of dealing with this small yet extremely vulnerable population? There are structured treatment plans for patients at risk for suicide, but the knowledge of this across all mental health professionals is limited. It takes a mediocre trained clinician to have the courage to want to treat the client’s plea for help and to stick with that person through this difficult time.
There are two clinicians who have revolutionized the understanding of suicidal thinking and behaviors. Dr. Ronald Holden at the Queen’s University in Canada and Dr. David Jobes at the Catholic University of America in Washington, D.C., have two forms that are easy to use and are not time consuming. These forms, the psychache scale (Holden, Mehta, Cunningham, & McLeod, 2001) and the Suicide Status Form (SSF;David A. Jobes, 2006) can be used in the first fifteen minutes of a session to assess the client’s mental health status.
Dr. Holden’s psychache scale is a thirteen question self report of items based upon Shneidman’s book, Suicide as Psychache (1993). Psychache is defined as despair, anguish, hopelessness, psychological pain one feels. Each items are ranked on a 5 point scale ranging from either never to always or from strongly disagree to strongly agree (Holden, et al., 2001). Scores are from thirteen to sixty-five.
The chorus is what brought me to write this paper. The following is the lyrics:
Where did I go wrong, I lost a friend
Some where along in the bitterness
And I would have stayed up with you all night
Had I known how to save a life
Sometimes in my own suicidal thinking I had wished “someone would have stayed up with” me all night. Just to have the reassurance that you are not alone and that someone cares that much, helps to diffuse the feelings of hopelessness and helplessness that the depression and weight of the world is bringing. It also helps to know that this difficulty will pass and the individual will get through this. It also helps to know that difficulties will pass and the individual will be able to move on. It is crucial that the individual knows this for tomorrow does not exist and the important thing is to get through today.
In Shneidman’s classic work, ¬Definition of Suicide, he states that “suicide should not be attempted while feeling suicidal” (1985, p. 139). The reason for this is because the thinking of the mind is focused solely like a never ending black tunnel. The constriction is so great; all you can think about is death and cessation. Time for them is in a warp full of pain and despair; there is no tomorrow. Their thinking is solely focused on what they need to do to ease their pain no matter what. Constriction is defined by Shneidman as the “honing in, the tightening down of the diaphragm of the mind. There is dichotomous thinking, a fixation on a single pain-free solution or death. Choices seem limited to two or one” (Shneidman, 1999).
Sometimes during this constriction, you are so overwhelmed by all that needs to be done you don’t know what to tackle first. This might be tasks at work, school, or just in general. Lists become an important tool that can help to prevent suicidal behavior. Dr. David Jobes at Catholic University created and designed a well focused, detailed, user-friendly form, called the Suicide Status Form (SSF, 2006). This form has three essential components that are initial, tracking, and outcome forms. Each section that both the client and clinician fill out to focus on the treatment plans, mental status at each office visit, treatment plan that the patient and clinician agrees to, and other relevant clinical material such as axis diagnoses for proper documentation. It essentially creates a written plan on getting better. The SSF is a very carefully made tool that clinicians can use to know how much pain, hopelessness, and likelihood the client may act on their feelings. This form is the best tool to know where the client is in their thought process because it clearly documents the distress they are feeling. The SSF also provides the client with a voice in their treatment rather than to have it dictated as the clinician seems fit, because after all “you do know best”. The client will feel more centered and relieved that someone is taking the time to listen to what is going on and work with them on what will work and what will not.
The next bridge is the crucial piece of what therapy is about:
Let him know that you know best
Cause after all you do know best
Try to slip past his defense
Without granting innocence
Lay down a list of what is wrong
The things you’ve told him all along
And pray to God he hears you
And I pray to God he hears you

According to Dr. Shneidman, “there are many pointless deaths, but never a needless suicide” (1995). Over his career, he has stated that the main element of suicide and suicidal thinking are frustrated needs. These are the “list of things that are wrong, things you’ve told him all along”.
In Shneidman’s Psychological pain assessment scale (1999), he lists twenty needs he feels are essential to the frustration one brings to think about suicide as an escape (for more detailed use of the scale, please see article). These needs are an adaptation of Henry Murray’s work, Explorations in Personality (1938).
The key to helping any suicidal person is to listen to what the person is saying. That is the most essential piece that any clinician can do. Jobes (2008) found in his clinical use of SSF’s one thing that was the level of the perturbation and stress involved with suicidal thinking as major correlate for suicidal behavior. This might be that pain becomes so jaded the person just doesn’t feel it and all they are left feeling is the urge to do something in the moment to relieve the pressure that is building up.
Learning new coping strategies may not be easy and some will work; others will not. In formulating this, it is up to the clinician to either “drive until you lose the road (client) or break with the ones you follow” (stick with what you know or try something different). O’Carroll (1996) did a survey of current assessments of suicide and found that not all clinicians (social workers, psychiatrists, psychologists, counselors) have the right definition of what it means to be suicidal. Each profession had their own beliefs and thoughts about what it means to be suicidal and propose a treatment for it. For a select few, some therapists even transferred the client to another clinician because of various reasons (David A. Jobes, 1995; David A. Jobes & Berman, 1993; David A. Jobes, Wong, Conrad, Drozd, & Neal-Walden, 2005; Joiner, Rudd, & Rajab, 1999; Joiner, Walker, Rudd, & Jobes, 1999; Meichenbaum, 2005; Michel, et al., 2002; Ramsay & Newman, 2005).
There is also David Rudd, et al (2006) Commitment to Treatment Statement (CTS). This is a formal written and verbal agreement, on paper, that the client is committing to live and as such, has decided to put suicide on hold to try and see if therapy can help achieve the goal of living rather than of dying. It is a novel way of thinking and is much better than the expense of the hospital (even though it might happen anyway) and the loss of life.
No one is an expert on suicide. There are predictive models that show the likelihood of risk factors that might cause a person to attempt. But these factors do not apply to everyone in the human race. Each suicide attempt or gesture is unique to that individual. There may be warning signs that go unnoticed until after an attempt or completed suicide. Psychological autopsies are valuable but they are too late to do much good to someone who is already dead. Their pain is no longer felt by them, just to those that knew them. You cannot save someone once they are dead. Nor can you learn much about the why and how they chose death to end their pain. As Dr. Shneidman points out, the best source of understanding suicide is through the “words of the suicidal person” (1996, p. 6).
In summary, these tools can be used in clinical practice. I know that most of these are not empirically based as of yet but does it matter to the client who is thinking these thoughts, is hurting so bad to want to end their life not to give it a try? You can “drive the until you lose the road, or break with the ones you follow”.

Lyrics to How to Save a Life: By The Fray (2005)

Step one you say we need to talk
He walks you say sit down it’s just a talk
He smiles politely back at you
You stare politely right on through
Some sort of window to your right
As he goes left and you stay right
Between the lines of fear and blame
You begin to wonder why you came

CHORUS:
Where did I go wrong, I lost a friend
Somewhere along in the bitterness
And I would have stayed up with you all night
Had I known how to save a life

Let him know that you know best
Cause after all you do know best
Try to slip past his defense
Without granting innocence
Lay down a list of what is wrong
The things you’ve told him all along
And pray to God he hears you
And I pray to God he hears you

CHORUS:
Where did I go wrong, I lost a friend
Somewhere along in the bitterness
And I would have stayed up with you all night
Had I known how to save a life

As he begins to raise his voice
You lower yours and grant him one last choice
Drive until you lose the road
Or break with the ones you’ve followed
He will do one of two things
He will admit to everything
Or he’ll say he’s just not the same
And you’ll begin to wonder why you came

CHORUS:
Where did I go wrong, I lost a friend
Somewhere along in the bitterness
And I would have stayed up with you all night
Had I known how to save a life

CHORUS:
Where did I go wrong, I lost a friend
Somewhere along in the bitterness
And I would have stayed up with you all night
Had I known how to save a life
How to save a life
How to save a life

CHORUS:
Where did I go wrong, I lost a friend
Somewhere along in the bitterness
And I would have stayed up with you all night
Had I known how to save a life

CHORUS:
Where did I go wrong, I lost a friend
Somewhere along in the bitterness
And I would have stayed up with you all night
Had I known how to save a life
How to save a life

References:

Holden, R. R., Mehta, K., Cunningham, E., & McLeod, L. D. (2001). Development and preliminary validation of a scale of psychache. Canadian Journal of Behavioural Science, 33(4), 224-232.
Jobes, D. A. (1995). The challenge and the promise of clinical suicidology. Suicide and Life-Threatening Behavior, 25(4), 437-449.
Jobes, D. A. (2006). Managing suicidal risk: A collaborative approach. New York, NY: Guilford Press.
Jobes, D. A. (2008). CAMs workshop (lecture 41st American Association of Suicidology annual conference ed.).
Jobes, D. A., & Berman, A. L. (1993). Suicide and malpractice liability: Assessing and revising policies, procedures, and practice in outpatient settings. Professional Psychology: Research and Practice, 24(1), 91-99.
Jobes, D. A., Moore, M. M., & O’Connor, S. S. (2007). Working with Suicidal Clients Using the Collaborative Assessment and Management of Suicidality (CAMS). Journal of Mental Health Counseling, 29(4/October), 283-300.
Jobes, D. A., Wong, S. A., Conrad, A. K., Drozd, J. F., & Neal-Walden, T. (2005). The collaborative assessment and management of suicidality versus treatment as usual: A retrospective study with suicidal outpatients. Suicide and Life-Threatening Behavior, 35(5), 483-497.
Joiner, T. E., Rudd, M. D., & Rajab, M. H. (1999). Agreement Between Self-and Clinician-Rated Suicidal Symptoms in a Clinical Sample of Young Adults: Explaining Discrepancies. Journal of Counseling and Clinical Psychology, 67(2), 171-176.
Joiner, T. E., Walker, R. L., Rudd, M. D., & Jobes, D. A. (1999). Scientizing and Routinizing the Assessment of Suicidality in Outpatient Practice. Professional Psychology: Research and Practice, 30(5), 447-453.
Meichenbaum, D. (2005). 35 Years of Working with suicidal Patients: Lessons Learned. Canadian Psychology, 46(2), 64-72.
Michel, K., Maltsberger, J. T., Jobes, D. A., Orbach, I., Stadler, K., Dey, P., et al. (2002). Discovering the Truth in Attempted Suicide. American Journal of Psychotherapy, 56(3), 424-437.
Murray, H. A. (1938). Explorations in Personality. New York: Oxford University Press.
O’Carroll, P. W., Berman, A. L., Maris, R. W., Moscicki, E. K., Tanney, B. L., & Silverman, M. M. (1996). Beyond the Tower of Babel: A Nomenclature for Suicidology. Suicide and Life-Threatening Behavior, 26(3), 237-252.
Quinnett, P. G. (1987). Suicide: The forever decision. New York, NY: Continuum.
Ramsay, J. R., & Newman, C. F. (2005). After the Attempt: Maintaining the Therapeutic Alliance Following a Patient’s Suicide Attempt. Suicide and Life-Threatening Behavior, 35(4), 413-424.
Shneidman, E. (1985). Definition of Suicide (softcover ed.). Lanham, Maryland: Rowman & Littlefield Publishers, Inc.
Shneidman, E. (1995). Definition of Suicide: Jason Aronson.
Shneidman, E. S. (1985). Definition of Suicide: Aronson.
Shneidman, E. S. (1993). Suicide as psychache: A clinical approach to self-destructive behavior. Lanham, MD: Jason Aronson.
Shneidman, E. S. (1996). The Suicidal Mind: Oxford University Press.
Shneidman, E. S. (1999). The Psychological Pain Assessment Scale. Suicide and Life-Threatening Behavior, 29(4), 287-294.
Slade, I. (2005). How to save a Life Retrieved may 21, 2012

Copyrighted 2012, Collerone, G

CBASP Cognitive Behavioral Analysis System of Psychotherapy

by Midnight Demon, posted in depression, mental disorders, mood disorders

J. McCullough’s article in the Journal of Psychotherapy, “Treatment for Chronic Depression:  Cognitive Behavioral Analysis System of Psychotherapy”, (CBASP; McCullough, 2003) is divided into three sections.  The first section talks about the psychopathology of depression and breaks down how to define whether the patient has early-onset or late-onset depression.  The next part discusses the methodology of treating the patient with CBASP.  The third part details the summary of data used in the article.

McCullough uses Piaget’s pre-operational thinking to characterize the primary, structural, cognitive-emotional problems that he believes maintain chronic depression.  His belief is that chronically depressed adults somehow enter therapy thinking and emoting at the level of four to six-year-old pre-op children (p245).  He also states that chronically depressed patients are perceptually trapped in the present moment and are unable to step back and view social, interpersonal events as an objective observer.  Because of their inability to use formal, operational thoughts, the patients get caught in their own structural and intractable worldview (p245).  They are also powerless to understand the reasons why others react to them in negative ways.  Self-statements made by such patients can be summed up in the words of one who said, “The world is the way it is because I believe it.  I also believe that people will always hurt and reject me.”  Logical disagreement and reality-testing techniques are rarely successful.

McCullough states that there are many parallels between the chronic patient and the pre-op children (p.245).  He uses the examples of a child clinging to the idea that thunder is caused by a heavenly game of bowling despite the parent’s logical explanation of a sudden disturbance of air by an electrical discharge (p.246).  Therapists might challenge patients’ negative thinking by pointing out the positive things for him/her, but they still feel they are ultimately being rejected by accusing the therapist of having been “trained to be nice”, or that the therapist might like them now, but that is because they don’t know they well enough yet.  The patient does not think logically; therefore, logical challenge is not successful.

In order to begin successful treatment, psychotherapy begins with an adult child who must be assisted to mature development in the cognitive-emotive sphere.  Using Piaget’s theory of cognitive-affective development provides the etiological sources that define early-onset and late-onset types of depression: one source involves infants and children (early-onset) and the other involves adults (late-onset; p249).

The chronically depressed patient feels powerless to accomplish anything, lives in an environment that doesn’t influence what s/he does, generating empathy with others beyond his/her capacity, and that s/he has no existential future as it was in the past and the future is much of the same (p252-253).

CBASP is designed to address these problems by relying on predominant administration of negative reinforcement.  Therapists keep exposing patients to the consequences of their behavior at every turn.  The purpose of this is to change the patients’ behavior in a positive direction when their discomfort/distress is diminished.

The techniques of CBASP are Situational Analysis (SA), Interpersonal Discrimination Exercise (IDE) and Behavioral Skills Training and Rehearsal (BST/R).  Each session is broken down to 75% of the time (45 min) administering SA, 15% of the time conducting IDE (9 min), and 6 min spent in direct BST/R.

SA is a technique that is essentially a mismatching exercise.  By using a problematic interpersonal event and focusing on a piece of interpersonal time that has a beginning, middle, ending, and a personal interpretation of the story in between.         Instead of talking about their problems in a global manner, patients are now required to focus attention on a specific problem and are prohibited from talk about problems in general.  This enables a fertile generalization and transfer of learning potential –one SA exercise easily generalizes to numerous interpersonal events.

There are specific consequences of behavior in SA: an endpoint of the situation called an actual outcome, (AO) and the desired outcome for the same event.  After pinpointing what the AO of the interpersonal event was, they are asked to construct a DO of what they liked to have happened.  This usually demonstrates behavioral consequences and ends up causing distress.  As the discrepancy between AO and DO increase discomfort, the first phase of the SA exercise makes negative reinforcement possible.  The distress is often relieved during the end phase of SA when the situation is “fixed” and the patients learn what they must do to produce DO (p. 255).  By repeating the SA, the patient practices with formal operational thought by considering possibilities if they behaved differently.

There are two phases of SA: elicitation and remediation.  These phases are combined in a series of questions that the clinician asks the patient.  The questions pertain to describing the event in detail, thought/feelings about the incident, how the situation turned out, etc.    McCullough points out that these cognitive interpretations in CBASP serves as a descriptor of what is taking place in the situational event.   Thus, cognitive interpretations are never disengaged from the AO or the DO and are discussed independently.  He further states that this approach to cognitive pathology represents one difference between CBASP and Beckian Cognitive Therapy (p. 255-256).

IDE is based on the disciplined personal involvement of therapist with their client and is designed to correct the person’s misconceptions of the clinician.  This is done during session two, during which the clinician obtains the significant other history.  This is a list of persons who have had a determining and influential impact on the course of the patient’s life.  Each of these people is then described in terms of how he/she caused the individual to be the kind of person he/she is. The causal effect may be positive or negative.  Although patients do not think causally, the significant other history is the first time CBASP patients are required to think (in a mismatching way) in an “if this/then that” manner.  Some patients find it difficult to complete the exercise and thus fail to make the connection.  When the exercise is completed successfully, the therapist has an easier time generating causal theory conclusions about each significant other.  These conclusions are descriptive statements concerning how these people influenced the patient’s life (p. 257).  Once these conclusions are made, new interpersonal realities can develop.  This development can override the patients constant thought of always being hurt and rejected and strengthen the closeness of the therapeutic relationship.  This can then mitigate early damage that was inflicted on the patient by the significant other (p258).

In the BST/R, patients are motivated to modify their behavior when they are aware their behavior has consequences.  Once they realize that these consequences end their entrapment in there chronic depressive disorder, motivation to change is potentiated.  Through individually tailoring of the patient’s social skill training, rehearsal, and practice, chronically depressed patients exits the CBASP program to manage the situational challenge they encounter daily.

The study that was conducted to compare the efficacy of medication and CBASP was the largest study ever conducted in psychology and psychiatry.  Six-hundred-eighty-one chronically depressed patients were enrolled at 12 research sites throughout the United States.  They were randomly assigned 12 weeks of nefazodone (Serzone), CBASP, or a combination of both.  Patients were to have a score of 20 on the Hamilton Depression Scale for Depression (HDSD-24) to indicate depression.  Remission was defined as a score of 8 or lower at week 10 and 12.  All patients presented with a current episode of major depression that lasted on average of 7.8 yrs.  Those subjects diagnosed with antecedent dysthymia revealed an average history of dysthymia of 23 years.

The overall response rate was 48% for the monotherapy cells and 73% for combined therapy.  All subjects were included regardless if the acute phase was completed.  The results showed that combination therapy for chronic depression provides meaningful clinical advantage (p.260).  It also supports previous recommendations for using both psychotherapy and medication to treat chronically depressed patients.

Criticism:

            This article on a personal level was intensely difficult to get through.  I do not agree with most of what the author was saying about the pathology of depressed individuals and I certainly don’t agree that the depressed patient is responsible for their depression.  Once you get past his interpretation of the psychopathology, the methods of treatment were easier to digest and take in objectively.  I was disappointed that the study was so short in this article.  The description of CBASP took almost twenty pages, while the study was a half a page.  Overall, the article is promising in the treatment of chronic depression.  He also gives a very detailed account of how the session is timed, which leaves no room for talking about anything other than the situational event and provides greater attention to interpreting the precise event rather than the emotional one.

 

 

McCullough, J. (2003). Treatment for chronic depression: Cognitive behavioral analysis system of psychotherapy (cbasp). Journal of Psychotherapy Integration, 13(3/4), 241-263.

 

© copyright 2013: Collerone, G

venting about mental illness and suicide

by Midnight Demon, posted in Chronic pain, chronic physical pain, mental illness, psychache, suicide, suicide attempt

Spent most of the day today watching my seven year old niece. She was playing on her computer while I was playing on mine. After I finished my games, I decided to read this new book I downloaded for research purposed, why do people have to die by suicide by Thomas Joiner, PhD. It is a good book so far and I find it stimulating. I have been taking notes which I probably will end up writing into a paper that I am working on.

I recently read an article about a mother who’s son has severe mental illness and behavior issues. Three days before the shoot out in CT, this mother had her son committed because he told her he was going to kill himself. The value of the message was to understand serious mental illness though I do not how much more serious mental illness can be. You have something that is mentally unstable. I have a serious mental illness that wants me to claim my life. I hear voices that taunt everything I do but I have never been violent towards another person and god help me, hope I never will. I just want to kill myself because I am a sorry excuse for a human being. I don’t blame my parents or my siblings for the way I turned out. It just happens to be who I am, I may not accept it but it is who I am. I know that some day I will ultimately end my life by my own hand. I know because I think about it every day. But I will NOT take another person’s life other than my own. Do I need to have a lifetime commitment because I am so suicidal? Probably but insurance companies don’t see it that way. As long as you are not in “imminent” danger to harm yourself or others, you cannot be allowed to stay in the hospital for more than a few days time, against your will. I have been there many times and even though I have chronic suicidality, I have never been kept beyond the three days or two weeks because of my suicidality. I might have been kept because the voices were telling me to harm myself, but never because I said I was suicidal after the three days. The mental health system is wrong and should be address these issues I am stating. Because maybe a longer admission is what I need to get better. I have intense psychotherapy with my therapist twice sometimes three times a week and still feel suicidal. I have been on every drug used for psychiatry and yet I still feel suicidal. How am I to live my life when I want to end it so much? How am I supposed to work and go to school when thinking about my death is all that matters to me? No hospital can change it. No psychiatrist can and no psychotherapist can. So the blame then gets shifted on to me. It’s my fault for not “wanting” to get better, that my negative attitude/emotions are what is causing me to be suicidal. If I change my attitude, I will be happier. It’s all bullshit. It’s not my fault being this way anymore than it’s a dying person with cancer fault because they have cancer. And believe me, I would much rather trade places with them because I know they are going to die while this “emotional cancer” is eating me alive and no one can see it. And no one wants to help me either. I can only save myself if I want to. Well, I give up. I don’t want to anymore. What purpose will living my life that I know is only going to end up six feet under. I have thought about cremation but the cost is the same. I thought about buying my own plot somewhere but I really don’t care what my family does with my remains. They are of no use to me anymore. So I am giving myself some time before I do it. And hopefully within this time frame things will change. Because if they don’t I am dead and there is nothing anyone can do to stop me.