Adolescent suicide prevention through cognitive-behavioral therapy and self-psychology

Adolescent suicide integration of CBT and self-Psychology

Adolescent Suicide: Integration of CBT and Self-Psychology

Determining why children and adolescents commit suicide is a concern that many individuals in the helping professions face. Obviously, they commit suicide because they are depressed in many instances, but it is also accurate to say that there are other reasons why many of these adolescents choose to take their own lives. Some of them are involved in substance abuse and other issues that cause them to think suicide is the right idea. Others are involved with crowds of other adolescents that drag them down into painful issues and problems that they have trouble facing. When this happens, some of these individuals begin to feel that they are trapped in these problems, and the only way that some of them find to escape those problems is through suicide. Tragic though it is, it becomes the choice all too often - especially when the adolescent already has a mental disorder.

As for who commits suicide, it appears that boys are four times more likely than girls to complete suicide, but girls are two times more likely than boys to attempt suicide (HHS, 1999). Among adolescents age 9-17 5% have depression, and depression can lead to suicide if it goes untreated (Shaffer, Gould, Fisher, Trautment, Moreau, Kleinman, & Flory, 1996). Between 1980 and 1997, the suicide rate in 15 to 19-year-olds increased by 11% and the rate of suicide in 10 to 14-year-olds increased by a staggering and troubling 109% (Stanard, 2000). Among those in the 15 to 19-year-old age group, suicide causes more deaths than any kind of disease, and in the 15 to 24-year-old category, suicide is the third leading cause of death, behind accidental death and homicide (CDC, 2000).

History of Adolescent Suicide

Originally, most of the information that was collected about antidepressant drugs was collected based on 'average-aged' adults, and because of this there was no hard evidence that they worked well and were safe in children and the elderly (Renaud, Axelson, & Birmaher, 1999). Newer evidence indicates that, in most instances, many of the antidepressant medications are relatively safe for most individuals, regardless of age (Renaud, Axelson, & Birmaher, 1999), although there have been very recent concerns about the suicide risk of Zoloft in the very young, especially. In general, however, medications are recommended for certain groups. These include those that are unable to or unwilling to undergo any kind of counseling, those that have not yet responded to counseling after 8 to 12 sessions, and those that have atypical or severe depression, recurrent depression, or bipolar disorder (Renaud, Axelson, & Birmaher, 1999).

The most widely used drugs are the selective serotonin reuptake inhibitors (SSRIs) such as Prozac and Paxil (Renaud, Axelson, & Birmaher, 1999). These seem to work the best in the adolescent population with the lowest side effects, and they are easy to use (Renaud, Axelson, & Birmaher, 1999). They also have a very low risk of death if they are taken in too large of a dose either accidentally or deliberately (Renaud, Axelson, & Birmaher, 1999). This does not mean that these are entirely safe for all young people, or that all depressed adolescents should be on medication. However, it does indicate that many of these drugs can generally be taken safely by most adolescents without much fear of painful side effects or dangerous behaviors that could harm the individual (Renaud, Axelson, & Birmaher, 1999).

There are specific clinical practice guidelines where depression is concerned. These are also important to discuss because they help others understand how depression is determined and treated. However, it is also important to note that various agencies have created their own guidelines for depression and that not all of them agree with the others. In short, there are several sets of guidelines that deal with depression, instead of just one universally accepted guideline that is used by all. In general, however, guidelines reflect information that there must be specific criteria for depression including: depressed mood; loss of interest or pleasure; significant weight or appetite change; insomnia or hypersomnia; psychomotor agitation or retardation; fatigue or loss of energy; feelings of inappropriate guilt or worthlessness; diminished ability to think or concentrate; and/or recurrent thoughts of death or suicide (Stanard, 2000).

The depressed mood or loss of interest or pleasure must be one of the symptoms that are found in the patient, regardless of the other symptoms (Stanard, 2000). Even though these guidelines exist, they are no real substitute for the opinion of a thoroughly trained individual and should not be used as an absolute when looking for depression, especially in adolescents, because they can exhibit symptoms that are different from others simply because their lives are often very different.

Depression is a very important issue, because it can lead very quickly to suicidal behavior in many individuals. Everyone gets depressed sometimes, but clinical depression is usually severe and long-lasting. If it is not treated, adolescents that have it can become so despondent with what is going on in their lives that they cannot see the point of living anymore. This becomes terribly painful for them, and if they do commit suicide, their parents, friends, and other loved ones are left in turmoil, anguish, and a lack of understanding about why it happened.

The numbers of adolescents that commit suicide have been growing, as well. It is unfortunate and troubling, but the numbers do not lie. The rate at which young people are taking their own lives is continuing to rise, and there does not seem to be anything that is being done or can be done about it. Medications do not work for everyone, and not all of the individuals that need help are getting that help. For those that do seek help, however, much of what they discover when they look for help is that therapies of different kinds can be very effective in treating them for depression. When the depression lifts, the desire to take one's own life is no longer there, either.

Throughout history, adolescents have often struggled with persecution, either real or imagined. Often, they feel as though they are not understood by anyone else, and this can keep them from enjoying their lives or from feeling as though they can talk to others when they have problems or need help. They do not feel like anyone will listen to them, and so they decide that they are not going to take a chance on trying to talk to anyone. Often, they do not even talk to their friends, even though it would seem logical that their friends of the same age would have similar troubles. However, most adolescents are not aware of the fact that their friends have problems, too. They feel that they are the only ones that are struggling with the issues that they face, and so they do not say anything to anyone else. They just struggle in their silent misery, until eventually they decide that they do not want to be here anymore.

With the problems that adolescents are facing today, it is actually not that surprising that they are struggling with depression, anxiety, and other difficulties. Peer pressure is becoming more common, and the age at which young people are experimenting with drugs, alcohol, and sex keeps getting younger. These children are put under tremendous pressures, and when they say that adults do not understand, they are right to some extent, because adults did not have to deal with many of these things at the same ages that their children are dealing with them now. This makes it difficult for adults to relate to what their children are going through in today's ever-changing society.

If adolescents all felt as though they had someone to talk to that would not only listen but actually understand their problems it would be more likely that they would seek help and get support when they needed it. This could help to lower the number of adolescents throughout this country with untreated depression, which could also work to reduce the number of adolescent suicides and suicide attempts each year. These young people would be able to grow up and be healthy and have a life ahead of them, instead of being forced to struggle through pain. There is always some pain and angst in growing up, and it cannot be avoided, but the extent to which it is seen and felt can often be adjusted. There are certainly ways to help young people, but finding these ways is a difficult issue that must be addressed more thoroughly.

Epidemiology of Adolescent Suicide

Many people seem to feel that depression in adolescents is just something that individuals go through and that there is no real reason to be alarmed. Instead, these individuals must accept these feelings as part of growing up. However, depression is very real, and it is a disorder, not just something that comes with age. These individuals cannot just 'snap out of' the problems that they are facing. All too often, these adolescents end up taking their own lives when their depression gets too painful for them and they have not received the help that they need. Even the medications that are designed to help them get through the depression can sometimes make things worse, as various medications for depression and anxiety carry a risk of suicide when people are just starting or just getting off of the medication.

Reviewing the literature about how to deal with depression in adolescents is very important, as treatment is needed in many cases. The first important concern for treatment is the psychodynamic approaches that are used. Psychodynamic approaches, or psychosocial approaches, generally translate in lay terms to counseling or therapy of some kind. This can be in a group or individually, depending on which way the therapist feels will be more effective, and the recent evidence into this issue shows that adolescents that are dealing with depression may find that this kind of intervention is often very effective in alleviating their depression (Lewinsohn & Clarke, 1999; Clarke, Rohde, Lewinsohn, Hops, & Seeley, 1999). One of the main reasons that a treatment approach is so important for these people is that around 15% of adolescents are viewed as being clinically depressed at some time in their teenage years (Montgomery, Beekman, & Sadavoy, 2000).

One study that was conducted by NIMH in 1997 indicated that adolescents that suffered from depression and were treated by therapists had a 65% remission rate and responded to treatment much more rapidly than adolescents that were treated with support and concern from their families only, instead of professional intervention (Brent, Holder, Kolko, Birmaher, Baugher, Roth, Iyengar, & Johnson, 1997).

This does not mean, however, that family therapy or intervention in the life of a troubled individual has no merit. Even those that did not have one-on-one counseling or therapy found that there was improvement when they were involved in a program that dealt with family therapy and coping skills. Not only did depressive symptoms show a decrease, but there was also significant improvement in problem-solving skills, interacting with family and friends, and overall social functioning in general (Mufson, Weissman, Moreau, & Garfinkle, 1999).

Adolescents clearly need support and help when they are depressed, just as individuals of any age group do. However, finding that help and support can be very difficult, because adolescents often do not know how to go about asking for help, or who to turn to. Often, they are not even aware that they are depressed. Instead, they just think that everyone feels this way, or that it 'will not happen to them.' Parents, siblings, friends, other family members, and teachers can compound the problem if they look the other way and insist that everything is fine when it is really not.

Sometimes, when an adolescent commits suicide, the parents insist that they never knew that their child was depressed, or that they never saw any signs that there was a problem. Usually, though, there are signs, and others either ignore these signs or they do not recognize them for what they are and therefore do not do anything about them. People obviously want to think that everything is all right. No one likes to acknowledge that they or someone they love has a problem. Despite this, though, the recognizing of and admitting to a problem with depression can save lives.

No parent should have to go through the pain of burying their child. When parents know that there is something that they could have done but they did nothing, that pain is magnified and intensified. An adolescent suicide can not only take the life of the young person but can ruin or severely damage the lives of the family members and friends, as well. This destruction damages society in that economic and social issues and affected, and people's lives are disrupted while they struggle to cope with the loss of a loved one.

Losing someone that was loved, especially if the loss is sudden or deliberate, can cause ripples that last in other people's lives for many years to come. Someone who commits suicide is often said to be selfish, because he or she did not think about or did not care enough about the pain that would be caused to others. This sounds relatively harsh, but it is also accurate. Most individuals that take their own lives do not spend much time thinking about how deeply their parents and friends will be hurt by it. Also possible is that they just assume that no one will actually care anyway, because they are so depressed that they cannot see past the pain that they are in to the grief that they will cause for others.

Risk Factors for Adolescent Suicide

Risk factors for adolescent suicide are many and various (Rubenstein, Heeren, Housman, Rubin, & Stechler, 1989). If an adolescent realizes that he or she is homosexual, that particular adolescent will have a higher suicide risk (Rubenstein, Heeren, Housman, Rubin, & Stechler, 1989). Homosexual adolescents are not the only ones that have this increased risk, however (Rubenstein, Heeren, Housman, Rubin, & Stechler, 1989).

Another risk factor for adolescents is having someone close to them commit suicide (Rubenstein, Heeren, Housman, Rubin, & Stechler, 1989). If the adolescent has been exposed to suicide early in life, they often have a stronger risk of committing that act themselves (Rubenstein, Heeren, Housman, Rubin, & Stechler, 1989). It would seem like an early exposure to a suicide early in life would frighten an adolescent badly and stop them from ever committing such as act, but it appears instead that there is a fascination with suicide at that point.

The highest, risk, however, is from adolescents that already have a mental disorder. Approximately 90% of the adolescents that commit suicide are found to have some kind of mental disorder (Shaffer & Craft, 1999). Twenty-one percent of those adolescents who actually did commit suicide has been to a mental health professional within three months of their death (Shaffer, Gould, Fisher, Trautment, Moreau, Kleinman, & Flory, 1996). This is indicative of the fact that they had a problem, but apparently did not receive proper treatment or enough treatment to prevent them from their suicide attempt. The most common diagnosis is usually a mood disorder, either with or without substance abuse and anxiety (Stanard, 2000). Having a major depressive disorder increases the suicide risk 12 times, and attempting suicide at least once before increases the risk by three times (Stanard, 2000).

There are few ways that suicide can be prevented in the adolescent population, but watching for warning signs and ensuring that interventions are begun early are the best ways to help as many individuals as possible. Even this will not help everyone, and adolescents with serious problems can still slip through the cracks. However, many adolescents can be saved if parents and others are paying attention to their children and what kinds of changes that they may see in their children.

When intervention is needed, there are several specific things that should be done. These include: ensuring that there is a clinical interview with the adolescent in question, observing the behavior of the adolescent, getting other information from significant others in the adolescent's life such as teachers, friends, and parents, assessing the risk factors and support levels that the adolescent has, and assessing the suicidal intent and reasons for living exhibited by the adolescent (Stanard, 2000). When all of these things are studied together, they help to create a much clearer picture of whether the adolescent is actually depressed and suicidal, and whether treatment is necessary.

This does not provide all of the answers, because there is actually no way to answer the question completely. There is no way that all suicides by children and adolescents can completely be prevented, but most of them could be prevented if parents and others around them were willing to recognize the signs and symptoms and speak up about them. Noticing the depression and not saying anything about it, or refusing to see it for what it is will not help the adolescent's struggle and may result in a suicide attempt if not treated. Parents and others who have frequent contact with adolescents must be watchful and mindful of the problems that many of these individuals face so that they can be protected and cared for as much as possible. This is the only way to lower the rate of adolescent depression and suicide.

Determining why children and the elderly (the two groups with the highest numbers) commit suicide is another concern that many individuals in the helping professions face. Obviously, they commit suicide because they are depressed in many instances, but it is also accurate to say that there are other reasons why many of these the elderly choose to take their own lives. Some of them are involved in substance abuse and other issues that cause them to think suicide is the right idea, especially with the amount of and the ease of getting prescription drugs in this group.

Others are involved with friends and other individuals that are already depressed and that drag them down into painful issues and problems that they have trouble facing. When this happens, some of these individuals begin to feel that they are trapped in these problems, and the only way that some of them find to escape those problems is through suicide. Tragic though it is, it becomes the choice all too often - especially when the individual already has a mental disorder or so many physical health problems that they feel suicide would be the best option.

Mental disorders are highly treatable, and so are many of the other reasons that adolescents choose to commit suicide. The main problem is usually not that treatment is unavailable, but that the adolescent does not seek the treatment that he or she needs. This can come from a lack of understanding of the real issue, fear of persecution by others, or simple defiance of society. Suicide can sometimes be seen as a defiant behavior, which will be discussed further in section VI.

The idea of committing suicide as an act of defiance is something that most people would not really think of, but yet it is very important to consider this as an option. There are all kinds of reasons why people - and adolescents in particular - take their own lives. Knowing more about the issues surrounding this problem can help to find ways to control the problem, get it stopped, or at least be aware of the warning signs and who is most at risk so that more people can be saved from themselves and their own deviant or dangerous behavior. Through doing this, young lives can be saved.

Often, not all of the risk factors for suicide are clearly understood and then, when a suicide does take place, the family and friends that are left behind do not understand how their loved one could have taken his or her own life when there were no risk factors present. In truth, however, there were actually risk factors that the people were not aware of. Once they find out what these risk factors were, they often feel guilty for overlooking them and/or not knowing about them. While this is obviously quite painful for everyone involved, it is possible that they will, in turn, be able to help others through the knowledge that they gained. If this is the case, then their loved one will not have died in vain. Even though this might not be much of a consolation for them, it will provide comfort, help, and solace for many other people that either have lost a loved one or that see warning signs in their loved one.

Self-Psychology

In Emile Durkheim's (1997) book Suicide, he discusses not only the reasons and causes regarding suicide but also the components of sociological theory that show it is not only what comes from within a person that matters but also their outside environment and the things that happen to them throughout their lives (Durkheim, 1997). This gives strong evidence that peer pressure and/or a lack of a good support system can affect suicide rates (Rubenstein, Heeren, Housman, Rubin, & Stechler, 1989).

Determining why individuals commit suicide is a concern that many people in the helping professions face. Obviously, they commit suicide because they are depressed in many instances, but it is also accurate to say that there are other reasons why many of these people choose to take their own lives, and Durkheim and others believed that deviance is one of the reasons that this takes place (Durkheim, 1997).

Durkheim and others believed that deviance can help to unify a group of individuals or a society because they have specific behaviors and norms that are accepted, and they have behaviors that are beyond the norm and therefore are considered deviant. When society has norms that are weak or conflicting, or when a person has those same kinds of problems, the chances for suicide are raised because the person does not feel as though they have structure in their life. It makes it very difficult to have a kind of balance in life, and individuals and societies both struggle with this issue.

Some of these people are involved in substance abuse (which is already deviant behavior) and other issues that cause them to think suicide is the right idea. Others are involved with crowds of other people that drag them down into painful issues and problems that they have trouble facing. When this happens, some of these individuals begin to feel that they are trapped in these problems, and the only way that some of them find to escape those problems is through suicide. Tragic though it is, it becomes the choice all too often - especially when the person already has a mental disorder or is struggling with other problems that he or she has not yet really faced and dealt with, such as who he or she really is and why.

Rebellion, the attempt to find individuality among the masses, and the independence of the people as being separate from the whole of the group are some of the things that have remained static for decades (Stone, 2001). While this is consistent, it is not a great comfort because it is indicative of the idea that some people will find individuality and independence from the masses by engaging in deviant behavior. In order to fully understand the issue, however, it must be understood why people commit suicide, what types of people are more likely to do so, and how this can be seen as being deviant or not being deviant, since there is argument on both sides of the issue.

Two main groups appear to have significant suicide rates that have been the subject of study. These are the elderly and adolescents, both of which will be discussed here. Both of these groups have problems with their suicide rates and also with the reasons behind the depression and suicide that they face, and both show deviant behaviors of different types. With adolescents, suicide risks come more from the problems that are faced with drugs, school, peer pressure, and other concerns. For the elderly, however, the reasons usually relate more to health problems, a lack of family and friend support, and other issues that people face as they get older (Giddons, Duneier, & Appelbaum, 2005). However, there can be many different societal causes for suicide, no matter what the age of the individual.

Here, therefore, it is important to examine the issues behind adolescent suicide as well as the issues behind elderly suicide, because not all reasons for this involve deviant behavior, although the view of what type of behavior is 'deviant' can be very different, depending on the person that is asked the question. This is important to remember, because deviance can take many forms. Generally, it is anything that is outside of the norms of society, but different societies have different norms. Overall, American society is very different from African society, for example, and what might be considered deviant in one society would not be deviant in another. Despite this, however, all societies have some form of deviant behavior that does not fall within the accepted norms.

All research findings are useful when the research has been conducted properly, as is the case here. The research discussed here works to remind others of the problems that many adolescents and elderly people are facing today - problems that their families and friends often forget about or overlook somehow because they do not wish to believe that it could happen to their relative or friend. Unfortunately, it can happen to any person, and sometimes many of the known risk factors are not present (Rubenstein, et al., 1989). Just because a particular person is at low risk for depression or suicide does not mean that it cannot happen, just as someone with a low risk for heart disease can still have a heart attack (Stone, 2001). It is less likely, but that does not make it an impossibility.

Despite this, the research findings do not present information that is new to the field. Because these research findings deal primarily with the information that has been collected from other studies, no new information has actually been provided. This does not mean that the information is not valuable, however, because Durkheim and others created many valuable insights and informative thoughts and beliefs that remain popular today, despite the fact that not all are in agreement with Durkheim's opinions and philosophies. Nevertheless, the information contained here still has value for those that lack an understanding of the importance of this topic and the seriousness of depression in the elderly and in adolescents.

Many people appear to think that depression in these groups is just a phase, but sullen, depressed behavior that lasts for a long period of time is not normal for anyone, and even the elderly dealing with health problems, the deaths of loved ones, and countless other issues should not be depressed for long periods of time (usually defined as more than two weeks) (Stone, 2001). The same is true for adolescents, as they often struggle with peer pressure and other issues but yet they should not remain depressed and angry for a long period of time. Mood swings are to be expected to some degree in all age groups, but these must be within normal deviation or they should be treated or examined in order to determine whether there is more going on than simply some moodiness that will soon fade (Stone, 2001).

When the elderly or adolescents exhibit these depressive symptoms for more than two weeks, they should be examined by someone trained in these matters to ensure the proper diagnosis is made, because it could be a matter of life and death. Whether it is 'deviant' behavior, however, is still a matter of debate. Durkheim was very interested in the concept of suicide and why it takes place, but yet even he did not seen to be able to make a complete determination as to whether suicide was considered to be deviant behavior. It would appear that it is not the actual act of committing suicide but the reasons behind the suicide that would affect whether it was termed to be deviant, since one suicide may be more 'deviant' than another, based on why it took place.

From Durkheim's perspective, any behavior that was outside the norm would be considered to be deviant, and while suicide is always a part of society, it is not the 'norm.' The group rules of acceptable conduct indicate that people do not kill themselves, and so when someone does this it is judged outside the norm by most of society. There are some, however, that would understand why a person would choose to take his or her own life, and that is also part of the norm. In other words, even though there are societal norms, it is also normal for some people to fall outside of that realm of normalcy. There are always exceptions to every rule, and societal norms are no different.

Durkheim also saw deviance as being created from disorganization and confusion, either within society or within a person. This makes sense, as individuals that do not 'fit in' with society often struggle with depression, anxiety, and other problems that can lead to suicide. Whether these people do not fit in because of who they are inside or because of who society wants them to be, however, remains a question. It could be different for different people, or it could be a combination of both, but it is clear that these kinds of problems can lead to deviant behavior which includes suicide. In light of this, it appears as though Durkheim's perspective would state that suicide is indeed deviant behavior.

Self-Psychology and Suicide

When intervention is needed, there are several specific things that should be done. These include: ensuring that there is a clinical interview with the adolescent in question, observing the behavior of the person, getting other information from significant others in the person's life such as family, friends, and others that might know the person, assessing the risk factors and support levels that the person has, and assessing the suicidal intent and reasons for living exhibited by the individual (Stanard, 2000). When all of these things are studied together, they help to create a much clearer picture of whether the person is actually depressed and suicidal, and whether treatment is necessary.

This does not provide all of the answers, because there is actually no way to answer the question completely. There is no way that all suicides by adolescents can completely be prevented, but most of them could be prevented if family and others around them were willing to recognize the signs and symptoms and speak up about them. Noticing the depression and not saying anything about it, or refusing to see it for what it is will not help the person's struggle and may result in a suicide attempt if not treated. Friends and others who have frequent contact with the person must be watchful and mindful of the problems that many of these individuals face so that they can be protected and cared for as much as possible. This is the only way to lower the rate of depression and suicide in the adolescent population as much as possible (Montgomery, Beekman, & Sadavoy, 2000).

Self-psychology has also been called self-analysis. Nowhere is this more common and popular than in dreams. Within the Western world the first important work written on the interpretation of dreams was created in the second century. This particular work addressed the many different types of dreams on various subjects. It was not until the end of the 19th-century that dream interpretation was seen as being part of psychoanalysis. Once this was the case, the content of the dream was analyzed to reveal hidden meaning based on the psyche of the dreamer.

Sigmund Freud was one of the leading individuals involved within this type of work. Freud wrote a book called the Interpretation of Dreams that argued for the foundation of dream content. It was believed that the foundation of all the content individuals see in their dreams was related to the fulfillment of their wishes, whether these wishes were conscious or unconscious (Freud, 2007). The theory that Freud created explains why the difference between the Id and the Superego often led to censoring dreams. The unconscious part of the mind would definitely like to depict in the dream having a wish completely fulfilled, but the area of preconscious mind would not allow that (Freud, 2007). Therefore, the wish that was seen within the dream was usually disguised and only understanding the structure that comes with dream work and dream interpretation could actually explain what the dream truly meant.

Within each dream that individuals attempt to interpret, there are generally many wishes on various levels. These can include a conscious wish for something in the immediate future or unconscious wishes that have much more to do with long-term goals and beliefs. There are four different types of transformations that Freud applied to wishes so censorship could be avoided (Freud, 2007). These were:

Condensation -- the idea that an object in a dream stands for many different thoughts.

Displacement -- the assigning of an object in a dream to a different object that will not raise suspicions.

Representation -- where a thought is simply translated into a visual image, and Symbolism -- in which a symbol seen in the dream replaces a person, idea, or action (Freud, 2007).

These specific types of transformations will help to disguised what is seen as the latent content of the dream, therefore having it transformed into the manifest content, or what is actually seen by the individual that is dreaming (Freud, 2007). Freud, however, was not the only individual who studied dreams. Another individual, Carl Jung, dealt strongly with dream analysis and analytical psychology (Hall, 1983).

His version of psychoanalysis used dreams as a critical part of the therapeutic process that he addressed. He did not dismiss what Freud had done with dream interpretation, but he also believed that the notion that Freud had regarding unfilled wishes in dreams was naive and simplistic (Hall, 1983). He was therefore strongly convinced that interpreting dreams had a much larger and much richer complexity than dealing with everything that an individual believed in their unconscious, both collective and personal (Hall, 1983).

In other words, he cautioned very strongly against simply ascribing a meaning to a symbol in a dream without understanding of the personal situation that the client was going through. There is some universality to various symbols, but this is not the same as an individual feeling that they received a sign, which is an image that has a connotation based on meaning for the specific individual (Hall, 1983). A symbol in a dream has to be explored based on the significance that it might have to the individual in question instead of having the specific dream conform to a predetermined idea that would be addressed for all individuals that have this particular symbol in their dream (Hall, 1983).

Jung also believed that there are many truths, illusions, fantasies, plans, memories, experiences, pronouncements, and even telepathic visions that are seen within dreams (Hall, 1983). The psyche of the human individual has a side that is experienced as conscious life, and therefore it also has been nocturnal and unconscious side which occurs in dreams (Hall, 1983). It is therefore argued that individuals who do not doubt how important their conscious experience is should also not doubt the importance of the unconscious experience of dreams.

In the new age, individuals still interpret dreams. This has become important with new age and pop culture. For example, Edgar Cayce claims that when people dream they give themselves access to their spirit, and that any questions that they could possibly have will be answered in their dreams from their inner consciousness if they are given the proper awareness of it (Bro, 1968). Shamanistic models of work dealing with dreams have gained popularity as the consciousness movement and the spirituality movement in this country and around the world has increased in recent years.

There are still many skeptics, however, that insist that dreams are just dreams. They are the product of the mind simply processing the day, they are random, and they mean nothing (Bro, 1968). After all, there is no scientific proof that dreams are important or that they mean anything, just as there is no scientific proof for the existence of God, ghosts, auras, or countless other phenomena. However, most people in the world believe in some kind of 'god' and they believe that there are things in this world that cannot be explained by 'normal' means, such as science. Because of this, the idea that dreams mean something and are important has remained with society throughout history (Bro, 1968).

There is also a strong difference where dreams are concerned when it comes to culture. Some cultures take dreams and dream interpretation more seriously than other cultures do. For example, the Asian culture has long been immersed in beliefs that seem to be more spiritual than those of the Western world (Bro, 1968). However, this does not mean that everyone in Asian cultures are spiritual and that everyone in Western cultures are not. Instead, it is more that the culture as a whole has more emphasis on spirituality but there are Asian atheists just the same as there are Western atheists.

Spirituality, including how one feels about dreams and what - if anything - they mean, is generally not a matter of culture but instead is a matter of personal choice and belief. It is also a matter to some extent of how the individual was raised, what kind of home life the person had, and whether his or her parents believed in dream interpretation and other parapsychological issues (Bro, 1968). All of these issues combine to effect belief and understanding when it comes to areas of life that cannot be seen or scientifically explained.

As can be seen, dreams can be both very fulfilling and a source of argument. Those that have good dreams, dreams that make them happy and seem to confirm what they believe will happen in their lives or what they want to happen in their lives, will likely put more stock in dreams. Conversely, those that have terrible dreams regarding pain and suffering, or those that have recurring nightmares about something bad happening to themselves or a loved one likely do not want to believe in dreams. This does not mean that they will not believe, which might leave them quite upset, but only that they would rather not believe or think that there is any truth to the idea that dreams might have significance.

However, it is important to remember that something happening in a dream or something seen in a dream does not necessarily mean that the thing will take place in 'real life.' It could be a symbol of something else. Because this is the case, those that believe in the power and interpretation of dreams may want to consult with individuals regarding these dreams and therefore come to a better understanding of them. If this can be done, the person that is having the dream is more likely to come to terms with the meaning of the dream and therefore understand more about himself or herself as well. This can lead to increased happiness, a desire to seek help if needed, realizations about the self, and countless other issues. It appears that spirituality overall is becoming more important in society today, especially in the Western world, and therefore it seems likely that dream interpretation will continue to be studied and evaluated into the future.

Psychology and Family - Gestalt Therapy

Being able to have family to relate to and have individuals that care is one of the most important facets for keeping families healthy. Too many individuals that are involved with depression, drugs and alcohol, and other suicidal behaviors are involved with this because they do not have families that care about them, or they think that this is the case.

Around fifty years ago, Frederick 'Fritz' Perls collaborated with Paul Goodman to create Gestalt Therapy. Perls had been educated in medicine and psychoanalysis, but later became interested in ideas beyond Sigmund Freud's. Influenced by many people of the day, Perls started to question the doctrine of orthodox psychoanalysis. During his life he wrote many books, and one of the major contributions he made to the study of psychology during the second half of the 20th century was to offer an alternative to the domination of Freud (Litt 2002).

Gestalt therapy came about when Perls decided that he wanted to construct a therapy that had its basis in the principles of Gestalt psychology. He attempted to carry the insights of the academic Gestalt schools into a much larger arena -- "that of psychotherapy, psychopathology, and personality. All of this work resulted in his second book, Gestalt Therapy, which was the culmination of his new therapy system (Litt 2002).

So what is Gestalt Therapy? That is a difficult question to answer, because there are so many variables that come into play. The German word 'Gestalt' doesn't have an English equivalent, and it conveys such a large variety of concepts: whole form, configuration, shape, and pattern. All of the meanings of Gestalt are drawn upon in Gestalt Therapy, and equal emphasis is placed on the "notion of the pattern," and the "organized whole" (Kirchner 2000).

The main concern in Gestalt Therapy is the fact that every individual is unique. Never are people reduced to parts and structure. Instead, they are viewed as a whole with the potential for growth. Gestalt Therapy focuses on the fact that the individual is part of a larger world, and makes contact with that world all of the time. The person cannot be considered without looking at the surroundings. An emphasis is placed on why the person is who they are, not how they came to be that way.

Gestalt therapy has many of its roots in the concept of existential philosophy, with concepts of phenomenology, humanism, and holism. To explain Gestalt Therapy fully, it is important to understand the other concepts it is derived from.

Existential philosophy encompasses issues of individual existence. Some other ideas of major importance to existential philosophy are the existential meanings of freedom, destiny, and the existence of God (Kirchner 2000).

Phenomenology grew from existentialism, and has its focus in "studying consciousness in its subjective meaningful structure and function" (Kirchner 2000). The founder of phenomenology, Edmund Husserl, had a very powerful impact on Perls (Kirchner 2000).

Humanism looks at self-actualization and uniqueness. It seeks to understand the human experience and to enrich that experience as completely as possible. Overlapping humanism and existentialism is very important to bring about greater understanding of human beings, and why they make some of the choices that they do (Kirchner 2000).

Holism is the belief that any human being is its own entity, and is self-regulating. It sees everything in the world as mutually dependent on everything else, and completely interrelated. Rather than seeing the whole as the sum of its parts, holism sees the whole as more than, but also very different from, the sum of its parts (Kirchner 2000).

According to Gestalt Therapy, there must be dialogue between one organism and another for them to relate to each other. All living is considered one human being meeting with another, and without this, there is nothing. This results in what is called an "I-Thou" relationship. There cannot be an "I" without an "It" or a "Thou." This relationship is seen as part of the contacting process which is vitally important in Gestalt Therapy (Kirchner 2000).

Four major concepts are used as the grounding for Gestalt Therapy's view of human nature: "biological field theory, the entity of the organism, the need for contact and relationship, and the capacity for making wholes" (Kirchner 2000).

Biological field theory is the concept that all organisms in any given environment have influences on each other. An organism can only be understood in the context of its surroundings and these reciprocal influences. Each organism is co-created by itself and its environment, rather than being individually created by itself or by its environment. It cannot be separated into components, but must be understood in its entirety.

The entity of the organism shows that any organism is a whole in and of itself, and its desire is the fulfillment of its nature and its growth to maturity. Organisms do not think and do in a random way, but rather they work toward a goal. Organisms regulate themselves, and outside influences can interfere with the self-regulating process and the healthy workings of the organism.

The need for contact and relationship is the "lifeblood of growth" (Kirchner 2000). Meetings with others cause feelings and emotions, and are therefore important for change and survival. One of the factors of existence is relating to others and to the world around us, and it is necessary for life that these relationships take place. Nothing can exist without relating to something else.

The capacity for making wholes is something desired by every human being. When an individual experiences something brought on by either internal or external factors, that individual learns something, and is therefore changed in some way. This process of learning and changing to part of growth. There is no way to keep experiences from having meanings for human beings and causing them change.

Gestalt therapy holds onto "the paradoxical theory of change," which states that to become something or someone else, one has to be who and what they are (Kirchner 2000). Even though humans may put effort and thought into the future, those things in themselves will not bring about the changes they desire. The truth of who a person is must be found and understood before that person can strive to become something else. Without the knowledge of who they are, all of the effort to be someone else will be for naught. All of the energy that is used by someone in discovering who they are and trying to change to become something else should be used to actively participate in all of the processes that occur in life.

Since the past and the future constantly get their bearings from the present, Gestalt Therapy is very interested in getting individuals to deal with something in the moment, and not attempt to project interpretations of that moment back into the past or outward toward the future. Gestalt Therapy does not ask the individual to deny that the past and future are important, it only asks that the individual acknowledge that reality is here in the present (Kirchner 2000).

The ultimate goal of Gestalt Therapy is to assist the person in the discovery or restoration of their own ability to regulate themselves and have fulfillment in contacts with others. There are, however, limitations on this therapy.

A fully elaborate theory of human development is currently lacking in Gestalt Therapy, and this causes some sufferings, such as those that are developmental in nature, to lack a consistent and theoretical explanation. Certain kinds of developmental problems are difficult for the Gestalt therapist to treat without knowledge of how the person's development accounts for contact over their lifetime (Kirchner 2000). There are attempts underway to change this, and they point to a promising future for Gestalt Therapy.

Explanation of Cognitive Behavior Therapy (CBT)

Biological approaches, such as medication, are the most common when it comes to treating moderate to severe depression in adolescents (Waxman & Carner, 1984). Despite the recent concerns that have been voiced about many of the medications on the market, they are still very popular among many doctors and patients that are struggling with depression. Many of the side effects that are seen in some that take antidepressant drugs are not found to be severe enough to stop recommending them for adolescents. Instead, warnings are placed on the bottles and they are still marketed. Whether this is right or wrong is not a subject for discussion here. It is enough to note that medication is still one of the most popular options for the treatment of depression in adolescents, and in other individuals as well.

Psychotherapists do many things but their main goal is to ensure the safety and well-being of their patients. Like others that practice medicine, they are all working toward things that they can do that will provide their patients with the most relief from their problems, and sometimes they are not even sure of the underlying issues that are causing the symptoms to develop. Unfortunately, as psychotherapy has evolved it has sometimes become routine for many of the therapists. There are rules and procedures for the way one should handle certain things, just like there are with any practice that helps individuals, and they have been developed over a long period of time (Keith, 2001).

This makes sense, but there are times when strict adherence to a specific way of handling something may not benefit a particular patient. Everyone is different, and because of this the psychotherapist must be able to adapt to new and different things that might be needed to help the patients that need them. They must see that they are traveling a road with their patient rather than see themselves as standing at one end and allowing the patient to either come to them or go the other way (Keith, 2001).

Some psychotherapists have a hard time doing this because they do not want to acknowledge the changes that psychotherapy has made over the years. However, it is important to acknowledge these changes, and the changing role of the psychotherapist, if one is going to truly understand what it is that psychotherapists do and how they help individuals so much with problems such as depression, anxiety, insomnia, and many other issues. The psychotherapists, unlike medical doctors, do not often probe the body for issues. They do however, probe the mind to try to find the underlying cause of whatever symptom is being presented by the patient in question (Keith, 2001).

Often the real issue is something that would often appear to be totally unrelated. The psychotherapist could easily treat the symptom with drugs or other interventions, but getting to the actual root of the symptom and finding the true cause of what is going on in the patient's life tends to be more effective and often does not require the use of medications which may have adverse side effects (Keith, 2001).

Because of this, the role of the psychotherapist is not the same as the role of the doctor. A psychotherapist is more of a teacher and counselor in a sense although they also must deal with medical issues at times. It is important to understand this role that the psychotherapist plays in one's life in order to understand how paradoxical treatments actually work and why psychotherapists choose to use them so frequently (Keith, 2001). They were not always so popular, and there were stereotypical ideas that used to belong to these types of theories. Many thought that they were not appropriate, and some even thought that they could be dangerous and were not really good for patients. However, understanding of them and what they could do eventually won out, and they are used a great deal today.

It is also important to note that the role of the psychotherapist has changed over the years but not to any great extent. The only issue that many psychotherapists are facing now is that the specific roles and guidelines that they have followed for a specific symptom in the past need to be reconsidered in the sense that everyone is different and the truly wise decision is to find out enough about an individual that comes in for treatment that the therapist can treat the patient and not simply treat the symptoms (Keith, 2001).

CBT Treatment Efficacy

The desire of paradoxical therapy is to get a client to deliberately engage in behavior that the client was before unwilling to engage in. This sounds very odd, but it is necessary to bring about change in the client's behavior. Paradoxical therapy has even been used for individuals that are suicidal, although this should not be intended to assume that suicide was the prescribed treatment (Linehan, 1993). Rather, paradoxical therapy was a label placed on some of these particular studies because there was really nothing else that the therapy could be called. It was not the standard cognitive behavioral therapy that many psychotherapists use. It was something different than that, and therefore it needed a label (Leary, 1986).

Some researchers are hesitant to use the term paradoxical therapy because there are stereotypical connotations that often come with this. However, in this case the researcher in question found that there was really nothing else that it could be called. Because of this, it was placed in the paradoxical therapy group even though it was not a case of prescribing a suicidal person to go out and do what they were discussing doing. This is obviously never done, even though it is likely that the person may not actually commit the act. It would be terribly unethical and wrong of any psychotherapist to suggest to anyone that they commit suicide, and this would never be acceptable (Leary, 1986).

Cognitive-behavioral therapy has become more popular in recent years, but there are a number of ways to apply cognitive-behavioral theory to treatment and not all of those in the therapy profession choose to handle this type of treatment in the same way. Much of this comes from the opinions that these individuals have regarding their clients. According to Albert Ellis, for example, much of the reason that people have personality disorders or difficulties is because of the way that they view events. They see events as 'good' or 'bad' and they become convinced that certain things cannot or must not happen. Because of this, they began to cause themselves anxiety and concern instead of learning to balance what might happen that is bad with the likelihood of something good happening. When they learn this balance, they will have less difficulty, but many people never learn to control this behavior and so personality disorders develop (Volpe, 1997).

Ellis also feels that the correction of a personality disorder may take a year or more of therapy. This is much longer than many other commonly treated disorders seen in many people. Because personality is so ingrained into a human being, changing one aspect of it that has been the same for a great deal of time often becomes difficult. Many people struggle with problematic parts of their personalities and never manage to change them, but those who sincerely want to correct a long-standing problem are usually able to do so through therapy (Ellis, 1974).

Wagner, however, focuses on the function of behavior instead of the form. In other words, she looks more at how the behavior makes the person feel or react (i.e. what it does for that person) as opposed to what the specific behavior actually looks like (Wagner, 2005). The therapy that Wagner uses also looks at whether the person has a strong history of not being validated, as this can cause many, many problems and behavioral issues regarding the thoughts and feelings that the individual has (Wagner, 2005).

As can be seen from the opinions and theories of these two different individuals, personality, how people use it, and what creates it is a debated topic that not all agree on. Some believe that personality changes over time, while others believe that personality is a genetically inherited trait that will remain basically the same throughout life, and some see the issue as not being as relevant as how the behaviors that are manifest by the personality of the individual make that individual feel. This does not mean that no changes in the way someone reacts to their environment will be seen as they grow older or that all behaviors are healthy, but that the basic way that someone looks at the world will not change that much over time. Those that believe that personality does not change do not feel that one can change who they genetically are, and therefore the traits that they were born with will always remain.

Whether one agrees with this line of thinking, or whether one believes that personality can (and should) change, it is certain that research into what makes human beings act as they do will continue far into the future as researchers, psychologists, and others strive to understand why people act as they do, how to correct problems that seem to stem from personality and genetic traits, and what can be done to ensure that everyone operates to their fullest extent and enjoys life as much as they are able to.

Personality, likely, is made up of all of the components that make someone human. There are internal issues, such as genetics, but there are also things such as birth order, child abuse, intelligence, fears, and reactions to the world. All of these things appear to work together to make up someone's personality, and there are no simple questions about someone that can be asked to help determine 'who they are' in relation to their personality.

CBT, Depression, and Suicide - the Use of Positive Psychology

One of the best ways to change behavior from a cognitive standpoint is through the use of positive psychology. The concept of positive psychology has been around for some time, but not under that specific name and not in exactly the same way as it is now. There have been changes made in the area of psychology in recent years, and positive psychology is at the forefront of these changes, because it looks at joy and happiness instead of depression and other mental problems and issues. Not everyone agrees with this type of psychology, however, and some individuals that work in the field of psychology believe that those that work with positive psychology are doing a disservice to their patients because they are not focusing on the real problems that the patients have, and instead just trying to get their patients to 'think positive' and avoid negative thoughts and ideas.

Positive psychology is not that much different from the other forms of psychology that were traditionally used in what it is trying to do, but only in the way that it does it. Most forms of psychology work at finding what is wrong with a person and looking for ways that it can be corrected. Positive psychology looks at what is right with a person and ways that it can be improved upon. This is a very different approach, and can make people feel good about themselves, but can also be discounted by many theorist that deal with psychology and personality theories. There are some that feel as though this type of positive psychology is not really psychology at all, but just a way of trying to make people better by showing them that there is much good in their lives, instead of having them focusing in on the bad. In this way, it is only a different way of thinking, instead of an actual theory or branch of psychology.

However, those that argue for positive psychology believe that psychology in general is just a way of making people think about their lives differently, and therefore positive psychology is also doing this, with the difference that it shows people their good traits and important contributions instead of showing them that they have problems that they must allow the psychologist to correct. Those that believe in positive psychology see this as being very groundbreaking, because psychology has always been designed to try to find fault with an individual or their personality and then make an attempt to fix that fault. Some of these people might not even be aware of some of their 'faults' if they had not been pointed out by the psychologist. Those that work with positive psychology do not do this, because they look only for the positive things about a person and how those can be improved on still further.

Psychology has many important goals, but some are more significant than others. The two most important goals of psychology are helping people and developing an understanding of human behavior. These two goals are most significant not only because they are the first things that many people think of, but also because helping people and learning about people have been the desire of many scientists and researchers throughout the ages.

First, helping people is a noble goal, regardless of what field of study one is in, provided the helpful intentions are legitimate, and are not for personal gain. When psychologists work to help people, however, both the patient and the psychologist benefit from the interaction. The patient benefits in obvious ways, as he or she is better understood and the problems that he or she faces are brought out in the open for analysis and discussion. This can help patients learn what their deep-seated problems really are and how to deal with them so that they can become happier and more productive members of society. Psychologists are also helped by this interaction. They not only get the satisfaction of helping others and seeing their progress, but they learn about themselves by learning about others. This can also be very important because the things learned from one patient can possibly be used to help other patients, and can also be used by the psychologist himself in his own life and difficulties.

Second, learning about people is not only important for the patient and the psychologist, but also for the scientific and psychological community. While learning that helps the patient, the psychologist, and other patients has already been addressed, learning for the entire psychological community is equally important, in that many other psychologists and patients can benefit from what is learned. Many psychologists discover very interesting things about their patients, and this information often gets put into their notes and eventually into research journals that are read by the psychological community. The far-reaching implications of this are obvious to even the casual observer.

Many more people can be helped by what different psychologists around the country and around the world are learning. By thinking about this, it can be seen that the two most important goals of psychology are really tied into each other in many ways, and that learning about patients creates more ways to help them. Psychologists have realized this, and they are interested in more new and innovative ways to treat problems that have plagued society for some time. Some of these problems require medication, but others can be cured with therapy alone, and these are the cases that are especially important to the psychological community, because therapy alternatives are not as easily advertised or as widely recognized as many medication options. This is certainly true of positive psychology.

It seems, upon reflection, that positive psychology is a science that is growing rapidly. More medications and more therapies are being utilized, and many problems that were previously considered to be 'all in one's head' are being recognized as biological and behavioral problems that need therapy and other means of help. By striving to learn about the problems and difficulties of their patients, psychologists are doing more research and finding new ways of helping their patients by being willing to open their minds to new ideas and innovations in their field. If this trend continues, psychologists all over the world will learn more about what they do, and patients all over the world will benefit from the experience that all of the better-equipped psychologists will bring to their sessions.

CBT and Family

Cognitive therapy is a very straight-forward way of working with patients. It works to identify painful thoughts and feelings, and then teaches the patient how to change their thinking in order to change their emotional behavior. Cognitive behavioral therapy uses behavior modification techniques such as anger management, while rational emotive therapy uses cognitive restructuring to change a patient's irrational beliefs. These beliefs can be very damaging to one's self-perception.

This type of therapy, however, is only one way to work with the family in a counseling environment. There are many other types of therapy that could also be employed. A clinical psychologist is trained to study the mind and the behaviors of people that are brought about by various mindsets. Those who become psychologists consider psychology a science, and they often discount others that deal with therapy on other levels as not being serious about what they do. They are interested in using specific, studied approaches to people's problems, and often work with individuals that have very serious mental problems.

In contrast, a psychiatrist is more interested in talking with the patient and listening to their responses. They are also able to prescribe medication for their patients, where a psychologist cannot. They want to help their patients discover things about themselves, and this is often done through the therapeutic approach of talking about problems and life choices to see if there are obvious ways to fix the problems and life stresses that many people face today. Social workers don't spend as much time talking with people as psychiatrists and psychologists do. They are more concerned with making sure that people with mental problems are taking care of themselves and their families than they are with discussing problems.

Concern is often over whether the person is holding down a job and taking their medication. A counselor does some of the same duties of a psychiatrist, but they are not as educated in the field. They won't be handing out medication to their patients, but they will listen to problems and attempt to help the patient as much as possible to lead a normal life.

ECT is Electroconvulsive Therapy. It is where a low-voltage current is passed through the brain under controlled conditions to induce a seizure and hopefully correct a mental problem. It is usually used for severe problems such as schizophrenia, but has been used for less severe problems as well. There are risks involved, such as severe seizures and memory loss. Brain damage can also occur.

Psychoanalysis tries to treat disorders by analyzing the patient in terms of how they respond to events in their lives, and how they react to situations. It also takes into account what may have happened in a patient's past that is giving them trouble in the present or causing them to have difficulty with planning their future. The goal is to find out the root of the patient's problem, which may not seem to have anything to do directly with the problem being experienced by the patient. Once the root of the problem is found, therapy is used to help the patient overcome their past and get on with their life.

Psychoanalysis has its limitations and drawbacks. It will not work for everyone, and many people don't want to delve that deeply into their past, especially if the memories there are very painful and have been repressed for quite some time. Because of this, people may quit this type of therapy instead of seeing it through, because they are afraid of what they might discover about themselves.

Cognitive therapy is a very straight-forward way of working with patients. It works to identify painful thoughts and feelings, and then teaches the patient how to change their thinking in order to change their emotional behavior. Cognitive behavioral therapy uses behavior modification techniques such as anger management, while rational emotive therapy uses cognitive restructuring to change a patient's irrational beliefs. These beliefs can be very damaging to one's self-perception.

The main assumption of humanistic therapy is that a person is who they are based on many different aspects. Because of this, humanistic therapy looks at not just one aspect of a patient's personality, but all of the inter- and intra-personal aspects that come with being human. One of the techniques used to create change in people is to study not just what they say and do overtly, but all of the nuances and other aspects of the information that they give to the therapist.

Systematic desensitization is the use of a feared object, slowly over time, to change how someone feels about that object. For example, someone afraid of snakes may be taught to get used to hearing the word, then to look at and touch pictures, then to touch the real thing. It is based on a framework of classical conditioning.

Behavior modification therapy is the most obvious therapy that takes advantage of operant conditioning principles. Generally, it works by either giving a reward for an encouraged behavior, or taking something away for an undesirable behavior. By doing this, the patient often increases the good behaviors and uses the bad behaviors less often, although this conditioning may take awhile if the rewards and removals are not sufficient to entice the patient into doing better.

Mutual respect and equality is the fundamental principle of family therapy. Often, this respect and equality has been lost, and this is the reason that the family is in difficulty. Once this has been restored, many other aspects of family and home life will be found to become easier as well.

A great deal of research into the effectiveness, both short- and long-term, of psychotherapy has indicated that the rate of improvement for those that were treated against those that were not treated was around seventy percent. The relapse rate for these patients in the first two years was also very small. Other research that looked at previous patients after five years showed that these patients had a low relapse rate as well, and that psychotherapy had indeed improved the quality of their lives as evidenced by their ability to do 'normal' things such as hold down jobs and have relationships with others.