In this issue
Here and now
News feature:听What turns the lights back on听(free article)
Sally Brown reports on what neuroscience is discovering about the effects听of depression on the human brain and the changes wrought by therapy
The big issues
In here you are always safe
Surabhi Chaturvedi talks to young homeless听people about how counselling helps
Grief is a process
Julia Samuel describes her search for the key that听could unlock Cheryl鈥檚 grief for her mother
Just listen to their stories
Lucy Johnstone and Jo Watson challenge the听biomedical thinking seeping into counselling
Epigenetics, evolution and the mind
Steve Heigham explains how evolutionary theory听can help explain clients鈥� here-and-now problems
Regulars
This much I don鈥檛 know
Wisdom from experience
Cautionary tales
A client mistakes self-disclosure for intimacy
Susan Dale unpacks the ethical issues
Research into practice
Liddy Carver explores the insights reflexivity听brings to qualitative research
Dilemmas
Older and forgetful, is Gerald still fit to practise?
Talking point
How do you attend to your personal safety?
Self-care
The healing powers of the night sky
Analyse me
What does your counselling room say about you?
Your association
A pdf version of this issue is available from the听Therapy Today听archive
Editor' note
There鈥檚 something a little contradictory about an issue that includes an article decrying diagnosis alongside another on neuroscience and the brain. But, as with all technologies, it鈥檚 their application, not the tools themselves, that so often is the problem.
As this month鈥檚 cover feature reports, brain scans are revealing fascinating data about the human brain, its immense plasticity and how changes in size and activity relate to different mental states. For depression, there are scans that show a literal lighting-up of vast areas of darkness after successful treatment.
The danger is that we then rush to conclusions about how and why those patches first grew dark and what made them brilliant with light again. Pharmaceutical companies like to think it鈥檚 the effects of antidepressants; counsellors and psychotherapists hope it鈥檚 their work.
It鈥檚 still the case that we don鈥檛 know what causes depression, and we鈥檙e still looking for answers as to how and why people recover. However, neuroscience does seem to be building a body of physiological evidence to illuminate the black box of hypothesis and conjecture about how talking therapies work.
There鈥檚 a salutary warning for the research community in a recent study that questions the conclusions of meta-analyses of randomised controlled trial studies evidencing the benefits of psychotherapy. We鈥檝e seen similar reviews questioning the validity of top-of-the range meta-analyses of drug trials and CBT. So, even the most scientifically rigorous of research methodologies can be flawed, and, tellingly, one of the most common contributory factors is researcher bias. Even in gold-standard research, the tools are only as good as the operator.
Catherine Jackson
Editor
My clients tell me that depression is a heavy, dark and lonely place to be. Faced with it, sometimes I feel like I鈥檓 crawling into a lake of deep mud, hand outstretched to catch a client who seems to be sinking under the weight of being in the world.
They ask, 鈥榃hat鈥檚 wrong with me? What caused it? How can I feel better, fast?鈥� Sadly, we don鈥檛 have enough answers. However, we can listen to stories, challenge cognitions and encourage improved self-care, and we can examine old wounds and look for new ones. Sometimes the cloud lifts quickly, as a short bout scuds by, but sometimes it sticks there stubbornly, like a disobedient black dog. Finally, we鈥檒l often glimpse a happier person emerging from the muddy gloom.
This month鈥檚 News Feature summarises the latest findings on the neuroscience of depression. It seems that the various talking therapies do help to lift it, but there鈥檚 still a way to go before we have all the answers.
Rachel Shattock Dawson
Consultant editor