I’m going to tell you a secret. I’ve never really mentioned it before because this secret is like a magician’s secret. I always fear that if I tell people this secret, they’ll never go to counseling. They’ll see the secret behind my proverbial rabbit out of a hat and the mystique of why therapy is good for you will be gone and no one will go.
But then I thought about it more and I realized I don’t want to present counseling as some sort of smoke and mirrors experience. I want to be honest and tell people what I know. So this is what I know…
There is no real “secret” behind how my profession works. There are three proven reasons for why counseling is successful:
1. The therapeutic alliance, which is just a fancy term for the relationship between the client and the counselor. It’s that whole “I got you,” thing. You should feel like your counselor gets you.
2. Appropriate therapeutic interventions (e.g. Cognitive Behavioral Therapy would not be appropriate for a toddler).
3. The client’s belief that treatment will be successful and their investment in the treatment process.
That third one is the big one. It’s the one I cannot control as a counselor. It’s my not-so-secret magic. I can get along with my client, I can learn and know the best ways to approach a client’s presenting problem, but I can’t make a client believe counseling will be successful. Sure, number 1 and 2 do a great job of supporting the outcome of number 3, but it’s not a guarantee. The client has to believe therapy will be successful for them and they have to be willing to actively participate in a therapeutic relationship with me. So, I basically just told you the counseling equivalent of showing you the secret magician door.
So, then I read this article this week that was published in the February 8, 2010 issue of Newsweek entitled “The Depressing News About Antidepressants,” by Sharon Begley.
It instantly made me think of the handful of e-mails I’ve received since I started the blog about my belief in the mind-body connection. I’ve had people with chronic pain, depression, and anxiety reach out and ask me to provide resources or just offer my insight. I’ve always tried my best to be supportive and offer resources, but I’ve felt like I had my eyes downcast, just shuffling my feet around and saying something like, “Yeah, and well, but you know…” but nothing that was really transparent and I ended up feeling like I didn’t communicate my thoughts about my belief in the “mind-body connection as the cornerstone of my professional ideology.” Kind of scary when I can’t explain my beliefs very well. Probably won’t help me later when I start having my own clients, huh?
I’ll try to keep it short, but I’m now ready to explain why I live my life and practice counseling the way I do, with the support of research findings outlined in this article. But first(!), I will give you some background information that I think is relevant to what I’m about to discuss. I think it’s important to understand the way antidepressants and most drugs approved by the FDA are evaluated for effectiveness. Patients in clinical trials who are classified as depressed are placed on either placebo or the drug up for approval. If some “statistical significance” (a wonderfully vague term) can be discovered between the symptom improvement in patients taking antidepressants versus those taking placebo, the drug is approved by the FDA barring any crazy side effects or reactions by those patients in the trial.
So, now that we have covered that little ditty, in the article Begley reviewed Dr. Irving Kirsch‘s work on comparing prescription antidepressant effectiveness in comparison with placebo effects in clinical trials. In 1998, Kirsch reviewed 38 different clinical trials for antidepressants that were performed since the beginning of antidepressant use in 1950s.
He discovered that antidepressants were really effective! That’s not really a surprise though, we’ve known that for years. What he found that was interesting was that 75 percent of patients on placebo reaped the same benefits as those on antidepressants. In other words, only 1 out of every 4 patients reaped real benefits from antidepressant use. Everyone else was relieved of their depressive symptoms because they believed the drug would make them happier. Not because it actually did make them feel better.
After that analysis was published, America’s antidepressant use more than doubled. We went from taking 13.3 million antidepressants in 1996 to taking 27 million antidepressants in 2005. People just saw that antidepressants worked. They didn’t care why.
The academic community and drug companies weren’t happy though. Criticism found it’s way in because it was scary that antidepressants had basically been found no more effective than a sugar pill. People accused Kirsch and his studies. They accused the data he used as being unreliable – which is strange because this data is what the FDA used to approve the drugs in the first place – so Kirsch pulled every study used to seek approval for an antidepressant drug by the FDA. He ended up with 47 studies, with 40 percent of those studies unpublished.
What did he find?
Not only had the unpublished studies failed to prove any “statistically significant” therapeutic effect, but the amount of unpublished studies far surpassed that of any other type of drug. Unpublished studies = The medication did not show any benefit to a patient. It’s okay though. A drug company can run as many clinical trials as it wants for a given drug. It just has to show two successes of statistically significant effect.
The percentage of those who saw the same benefits with placebo as with an antidepressant increased. About 82 percent of patients across the board showed no better outcomes than with placebo. So now, about 18 percent of those on antidepressants actually saw a needed benefit.
Well, what about those 18 percent – 25 percent who benefit? How greatly do they benefit from an antidepressant?
Not by much. On a 54-point scale measuring various markers of depression, the average patient saw an improvement of 1.8 points. That’s about a 3 percent symptom improvement. It’s like having a terminal illness and waking up one day and realizing the cough from your cold is gone. Not much effect on the underlying issue, which once again cycles back to how we choose to look at and cope with life.
The point of it all.
This is a prime example of the mind-body connection and how it effects treatment. The rabbit coming out of the magician’s hat is simply the client’s belief that therapy/antidepressants will be a success.
The difference is a big one though. With antidepressants, patients experience a host of side effects. Some common side effects of antidepressants include:
- Lack of sex drive
- Dry mouth
- Weight gain
- Blurred vision
With the list going on…
With counseling, there are side effects as well. In the beginning, counseling can be uncomfortable, it can force you to look at things you may not like about yourself, it brings your presenting concerns to life and requires you take an active role in changing your world view and the way you cope with life.
Part of that is how you think. Whether you choose to believe in the effectiveness of counseling or antidepressants, your powerful thought in the belief of change has already begun to change your life. The difference with counseling is that you develop greater self-awareness, better coping mechanisms, and you develop a healthy relationship with another person who is an advocate for your well-being and an impartial observer on your life experience.
The most important point I want anyone who reads this post to take away is that it’s changing how you think that is the catalyst to change. When we think nasty thoughts about ourselves and our life, it causes a chain reaction in our bodies. We release nasty hormones like cortisol and adrenaline (which can be good, but is often in overabundance under stress). When we think good thoughts and we believe we can change, we do. We do it through changes big and small. It’s the difference between a patient who is fighting cancer who beats it or succumbs to it. It’s the philosophy behind “spontaneous remission,” which is basically how doctors explain miracles or unexplainable cures of disease.
So, I believe in the power to change your thoughts and beliefs. This is my professional and personal ideology. I believe you can do anything you set your mind to no matter what it is. You want to stop being depressed? Believe you’ll stop being depressed and change the things in your life that contribute to your depression. You know how you figure those things out? Self-Awareness.
I hope I explained myself a little better and you all understand my summary and my beliefs. It is important to note that antidepressants are often proven to be beneficial to those who have suffered from recurrent and severe depression and may help where psychotherapy and other interventions have not. It also been proven that therapy is effective for those who do not have these problems. There is always a choice and one is not necessarily better than the other. Some people are content to not go to counseling for one reason of another. That’s okay, too.
There’s a lot of other issues that go into why prescription medication is so ubiquitous and opted for more often than counseling (i.e. stigma of therapy, support in government for Big Pharma versus mental health services, and insurance inconsistencies). I don’t want to address those issues right now.
I simply want to acknowledge that about 75 percent to 82 percent of the time, you are likely your own placebo on the path to your happiness. That is how I feel about the mind-body connection.
Thank you for reading to the end of this post and please comment with your thoughts. I’m always interested in hearing others’ thoughts, as long as they speak for themselves. Remember “I statements…“
Post Edit: My sister kindly posted out that statistical significance isn’t vague, it’s actually numerical. I was speaking existentially, but if you’re curious here’s a definition.