In this issue

Here and now

News feature: What turns the lights back on (free article)
Sally Brown reports on what neuroscience is discovering about the effects 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 people about how counselling helps

Grief is a process
Julia Samuel describes her search for the key that could unlock Cheryl’s grief for her mother

Just listen to their stories
Lucy Johnstone and Jo Watson challenge the biomedical thinking seeping into counselling

Epigenetics, evolution and the mind
Steve Heigham explains how evolutionary theory can help explain clients’ here-and-now problems


This much I don’t 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 brings to qualitative research

Older and forgetful, is Gerald still fit to practise?

Talking point
How do you attend to your personal safety?

The healing powers of the night sky

Analyse me
What does your counselling room say about you?

Your association

From the chair

Cover of Therapy Today April 2017

A pdf version of this issue is available from the Therapy Today archive

Editor' note

There’s 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’s their application, not the tools themselves, that so often is the problem.

As this month’s 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’s the effects of antidepressants; counsellors and psychotherapists hope it’s their work.

It’s still the case that we don’t know what causes depression, and we’re 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’s 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’ve 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

My clients tell me that depression is a heavy, dark and lonely place to be. Faced with it, sometimes I feel like I’m 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, ‘What’s wrong with me? What caused it? How can I feel better, fast?’ Sadly, we don’t 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’ll often glimpse a happier person emerging from the muddy gloom.

This month’s 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’s still a way to go before we have all the answers.

Rachel Shattock Dawson
Consultant editor