Quality Cognitive Therapy Available?

[sleepyjohn]

I have a friend who is undergoing a quite serious depression, not for the first time, and not for the first time has been prescribed meds but no other therapy after a 15 minute consultation and come back in two weeks. She agrees this is inadequate and was already on SSRIs with no great outcome. She has since at least gone to her old doc and been reduced to SSRI and modest benzo dose.

I believe she is not in a condition to make decisions for herself and I want to help.

I have offered her that meds can be useful but may get her nowhere if nothing changes in her life. She agrees.

In my opinion the best change that could happen is in her mind through CBT. This stuff works if done properly.

I would like to know if quality CBT is available here. She is in BKK right now with her family but CM is a possibility.

If anyone kindly gives reference or opinion could they please back it up if possible.

Someone mentioned one of the BKK universities psy dept as being up there.....?

[mrtoad]

sleepyjohn, there are a number of places available in Bangkok. If you look at the Mental Health Resource list pinned in this forum you will see several reputable organisations with contact details. My undersatnding is that they are all accredited practitioners which is something that you should establish before any consults. I beleive that one of the mods on this site also works for one of the services.

I certainly agree from what you're initial post has said that a 15 minute consult and PX of SSRI's is hardly going to make a significant improvement if this is a person already has a history of depression. Unfortunatly that is often the way that GP's around the world believe is the way to treat depression. CBT is a very effective form of therapy for this type of illness and in conjunction with suitable medication and appropriate support from family and friends results are normally very positive.

I hope that it all works out.

[Sheryl]

Fully endorse what Mr Toad said above. Check out the pinned resource list.

Depression does indeed usually respond best to CBT plus meds if serious, otherwise CBT alone.

However in addition to CBT I am wondering about her meds. Benzos are not a good choice in depression except possibly as a short-term sleep aid and should certainly not be taken in the daytime.

The SSRIs vary in how quickly they take to work. Prozac for example takes a very long time and has been linked to suicides in part ofr that reason. Of course, making a linkage between SSRIs and suicide is always difficult given that both are linked to depression, but Prozac and other SSRIs with relatively long half lives seem especially so. A dear friend of mine lost her husband to suicide just about a week after he started on Prozac, which was not enough time for it to have kicked in but enough time for his despair to overwhelm him. I suspect has he been put on a shorter-acting SSRI this might have been averted.

Do you know exactly what SSRI she is on and the dose?

Lastly, have phsyical causes such as hypothyrois been excluded?

[sleepyjohn]

Thankyou both for your opinions.

I hadn't thought of thyroid problems Sheryl I shall mention it.

It seems to me with the best of evidence that there's no such thing as a pharmaceutical free lunch. This seems so obvious that I have to say I'm rather cross about the way things are normally done.

........and would still love to come across a brilliant personal recommendation to help put a smile on her face......

[Orangutan]

Carl Janowitz Clinical Psychologist at Bumrungrad Hospital...very good.

-O

[sleepyjohn]

Carl Janowitz Clinical Psychologist at Bumrungrad Hospital...very good.

-O

Thankyou Orangutan

what makes you think he is good?

My friend is Thai and though not poor fees would be a factor as I'd say three visits a week for some time would be necessary. Any ballpark idea of an hour rate?

[Sheryl]

If she is Thai she may do much better with a Thai therapist. Even if her English is very good, it is hard to do therapy in other than your native tongue, plus of course cultural issues may hamper therapist-client communication, Try:

NCS New Community Services

61/1 Soi Intamara 3

Sutisan Road

Phaya Thai (Sapan Kwai Area)

Tel.: 0-2279 8503

Fax: 0-2279 8502

[email protected]

This was described by a TV member who is a mental health professional as " The only clinic in Thailand I know if where well trained Thai counselors work side by side with well trained and credentialed foreign mental health professionals. This is place to refer your Thai friends to for western style counseling."

[mrtoad]

If she is Thai she may do much better with a Thai therapist. Even if her English is very good, it is hard to do therapy in other than your native tongue, plus of course cultural issues may hamper therapist-client communication, Try:

NCS New Community Services

61/1 Soi Intamara 3

Sutisan Road

Phaya Thai (Sapan Kwai Area)

Tel.: 0-2279 8503

Fax: 0-2279 8502

[email protected]

This was described by a TV member who is a mental health professional as " The only clinic in Thailand I know if where well trained Thai counselors work side by side with well trained and credentialed foreign mental health professionals. This is place to refer your Thai friends to for western style counseling."

Sherly has made a very valid point. I'd certainly suggest that a therapist should be someone from the same cultural background and language, as there are potentially too many issues that may hamper effective therapy.

[sleepyjohn]

Thankyou Sheryl

[benw]

Here is another idea for your friend: [new info since resource list compiled] I just completed facilitating a 13-month CBT training program for Thai psychologists, psychiatric nurses at the Somdej Chao Phraya Psychiatric Institute. I learned an amazing amount while doing this, esp about doing psychotherapy with Thai clients. There are important and relevant differences, so for cognitive therapy, it's really better not to send your friend to a western therapist, IMHO (unless your friend lived abroad for a significant period and is very very sympatico with western ideas and principles).

There are some working at Somdej Chao Phraya Psych Inst I think are really good therapists for Thais, if the Thai person in question can overcome stigma and contact them. Have your friend call the institute and ask for the psychology department. I recommend s/he contact Ajarn Nakorn or Khun Sujitra or Khun Supan- these folks have extensive training in CBT, and are good therapists as well (the two don't always go together ;-)). I've been especially impressed with Nakorn and Sujitra, and Supan has a lot of CBT training (she's also a research therapist in a major outcome study of CBT here in Thailand). Once s/he has reached the department, they can ask to speak with one of those three and ask for an appointment. Recall that this is a public facility, so there may be a wait and appointments will not be available outside regular working hours. Hope this helps

[sleepyjohn]

Here is another idea for your friend: [new info since resource list compiled] I just completed facilitating a 13-month CBT training program for Thai psychologists, psychiatric nurses at the Somdej Chao Phraya Psychiatric Institute. I learned an amazing amount while doing this, esp about doing psychotherapy with Thai clients. There are important and relevant differences, so for cognitive therapy, it's really better not to send your friend to a western therapist, IMHO (unless your friend lived abroad for a significant period and is very very sympatico with western ideas and principles).

There are some working at Somdej Chao Phraya Psych Inst I think are really good therapists for Thais, if the Thai person in question can overcome stigma and contact them. Have your friend call the institute and ask for the psychology department. I recommend s/he contact Ajarn Nakorn or Khun Sujitra or Khun Supan- these folks have extensive training in CBT, and are good therapists as well (the two don't always go together ;-)). I've been especially impressed with Nakorn and Sujitra, and Supan has a lot of CBT training (she's also a research therapist in a major outcome study of CBT here in Thailand). Once s/he has reached the department, they can ask to speak with one of those three and ask for an appointment. Recall that this is a public facility, so there may be a wait and appointments will not be available outside regular working hours. Hope this helps

This sounds like excellent information and a real possibility thankyou.

Completely as an aside and not relating it to this case I would be interested to know your take on the fact that studies showed even reading the top rated "Feeling Good", so called bibliotherapy, had equivalent results to actual person to person therapy. A control group who had the book withheld for a month responded with like results a month later.

Edited August 22, 2007 by sleepyjohn

[benw]

[This sounds like excellent information and a real possibility thankyou.

Completely as an aside and not relating it to this case I would be interested to know your take on the fact that studies showed even reading the top rated "Feeling Good", so called bibliotherapy, had equivalent results to actual person to person therapy. A control group who had the book withheld for a month responded with like results a month later.

This is a really interesting area. I'm not completely up to date on it, although I recently went to an ACT workshop where they reviewed research on various delivery modalities (ACT is a third-generation cognitive-behavioral therapy). My recollection is not that bibliotherapy is equivalent to individual psychotherapy. My recollection is that bibliotherapy by itself is effective for some folks, but not as effective as therapy on average (not referring to just 1 or 2 studies, which have shown equivalence between books and 1-1 for a specific sample with the specific problem studied, but to reviews of studies, called meta-analyses). The effectiveness of bibliotherapy makes sense to me in that there are plenty of ways people can help and heal themselves. Especially when problems are less severe or less chronic, many people are able to find their own path to healing, using their own natural resiliency. Psychotherapy is just one method, one modality that helps people; there are plenty others. Also, my recollection is probably wrong, or at best, biased. The fact that it may not be as helpful for some people as individual psychotherapy also makes sense to me. It seems to me that every single one of us has blind spots- you, me, everybody. The thing is that we all have different blind spots. When someone sits in a room with a book, they still don't necessarily learn about their blind spots- blind spots are learned about experientially- in the same way a person can learn sitting with another person. Sometimes that person can be a friend, and sometimes not (one reason that psychotherapy exists is that we all share certain blind spots, for example around emotion or culture, which therapists are systematically trained to be aware of).

I have seen clients who tried bibliotherapy (in some cases, given a book after one session with a UK NHS provider) and whom it didn't help. Usually, by the time someone comes to see me, they have already tried a bunch of different things. They come to see me because those other things have not produced the results the person wanted/hoped for. So my view of life is biased- I don't see the people for whom something else- some other form of healing- worked. In my work, I frequently combine bibliotherapy with individual psychotherapy- the only challenge is finding books that I think are worth asking people to read.

These are my thoughts. I'm probably wrong. I just don't know how I'm wrong yet!

[Ijustwannateach]

Good thread. Eventually I will merge some of this with the pinned resources thread.

[sleepyjohn]

Good thread. Eventually I will merge some of this with the pinned resources thread.

I agree it is a very interesting area BenW.

We all tend to believe that our thinking is influenced by our feelings, whilst evidence shows it is the other way round, the thinking creates the feelings. As it's the feelings that count, we should do our best with our thinking.

I was impressed enough that I got a copy of Burns' Ten Days programme and did the steps as an experiment. I then recognized irrationalities in myself, and I believe this would be common to most all of us. I went about it in the systematic way suggested. When I started practising replacing unsalubrious thinking with counterviews, considered and hopefully rational, I could actually feel it making a difference right then and there.

I suffer from patterns of irrational thinking commonly labelled agoraphobia which for nearly four years has rendered me unable to leave Chiangmai and earn a living. I am slowly overcoming it and I hope CBT may be another tool. I believe however that everyone would benefit from learning and practising this stuff. I believe we all have noxious thinking in our daily lives which is well worth exposing.

It is well that you recognize possible biases in your clientele.

As another aside as you are interested in irrational thinking and self manufactured happiness, you may be interested in the marvellous expose of cognitive dissonance and consonance, people sticking to views even when they're downright wrong

"Mistakes were made (but not by me)"

http://blogcritics.org/archives/2007/06/04/184150.php

and another you have probably read but maybe interesting to the forum

"Stumbling on Happiness"

A short excellent talk by Dan Gilbert is available on

http://www.ted.com/index.php/talks/view/id/97

I consider his theme to be pivotal.

Edited August 22, 2007 by sleepyjohn

[unblocktheplanet]

I'm very grateful to TV for keeping great resources like this thread available for when people need them. That said, some of the info may well be out of date.

 

Thyroid is often the problem with anxiety, depression, sleeplessness, fatigue & it can be devilishly hard to get to the right treatment. Most possibilities are simply not available in Thailand, tests are limited, and no doc I've found thinks outside the box.

 

The psychiatric outpatient dept at Chulalongkorn Hospital is brilliant. One usually sees a young resident. In my limited experience, they are caring folks and give patients as much time as they need. But coming out of medical school, they've all been brainwashed to push patients onto pills. I don't recall seeing reliable talk therapy at Chula such as CBT.

 

I think most foreigners who've chosen Thailand as their permanent home get somewhat isolated. But I'm not sure it would be much different if one lived in Manhattan.

 

Another factor, of course, is the cost. Many of us are on limited incomes with no pensions and have that 800k locked up in a bank. So who can afford Bumrungrad?!? Think about it: we expats are supposed to be contributing members of Thai society not needy basket cases.

 

Although a list of CBT and other psych services was mention by an OP, I couldn't find one here. Hope someone can update with current availabilities. Thanks to all. (Sometimes sleepless!)

[Sheryl]

This is the list

https://forum.thaivisa.com/topic/90910-mental-health-resource-list/

 

One does not get CBT at a hospital and hospital pysch services are indeed geared towards medication - these are psychiatrists, not pyschologists.

 

As shown in thel istm there are soem good, western pcousnellors abailable in bangkok. Upcountry it is harder, less available.