Category Archives: Psychotherapy

Does Money Buy Happiness? No, And The Answer Of What Does Buy Happiness May Surprise You

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It is often said that money can buy happiness, and as I’ve blogged in earlier articles, this is true, but only up to a basic middle-class economic status. Above that, money doesn’t seem to add much happiness. (See my posts here and here.)happiness

So what does buy happiness? We have a surprising answer from our friends across the pond, at the University of Warwick in England. A new study published online Nov. 18 in the journal Health Economics, Policy and Law surveyed thousands of people on their levels of happiness and correlated it with external factors such as a pay raise or winning a lottery prize, and compared this to receiving psychotherapy.  Astonishingly, even to me, a psychologist, the increase in happiness from a $1329 course of therapy was so large that to equal it people had to get a pay raise of more than $41,542! That’s a ratio of 32 times! That means a dollar spent on therapy boosts happiness 32 times more than the same dollar received in a pay raise or lottery prize.

As the study author Chris Boyce, of the University of Warwick, summarized:  “Often the importance of money for improving our well-being and bringing greater happiness is vastly over-valued in our societies. The benefits of having good mental health, on the other hand, are often not fully appreciated and people do not realize the powerful effect that psychological therapy, such as non-directive counseling, can have on improving our well-being.”

Bravo, Chris! Now when patients ask me whether therapy is worth the money, I can confidently say that research suggests it might be one of the best investments you can make in yourself and your own happiness. (And it’s okay to get a raise, as long as you spend it on therapy!)

The only problem I can see with this article being published is that it may lower MY happiness, as I might get busier, perhaps earning more money, but not having time to see my own therapist!

So to answer the original question, does money buy happiness? Money doesn’t buy happiness; it buys psychotherapy, which yields 32 times more happiness than money!

Copyright © 2009-2010 Andrew Gottlieb, Ph.D.  The Psychology Lounge/TPL Productions

 

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Dr. Andrew Gottlieb is a clinical psychologist in Palo Alto, California. His practice serves the greater Silicon Valley area, including the towns of San Jose, Cupertino, Santa Clara, Sunnyvale, Mountain View, Los Altos, Menlo Park, San Carlos, Redwood City, Belmont, and San Mateo. Dr. Gottlieb specializes in treating anxiety, depression, relationship problems, OCD, and other difficulties using evidence-based Cognitive Behavioral Therapy (CBT). CBT is a modern no-drug therapy approach that is targeted, skill-based, and proven effective by many research studies. Visit his website at CambridgeTherapy.com or watch Dr. Gottlieb on YouTube. He can be reached by phone at (650) 324-2666 and email at: Dr. Gottlieb Email.

Depression Often Misdiagnosed, and Untreated

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The New York Times had an interesting article about how depression is often misdiagnosed in the US, and how most people who actually have depression don’t get treatment.  They reference a research study just published in the JAMA Internal Medicine.Depression

This research study performed by Mark Olfson, Carlos Blanco, and Steven C. Marcus, looked at responses from 46,417 people on the Patient Health Questionnaire-2 (PHQ-2) which is a brief screening tool for depression. A score of over 3 indicates depression on this scale.

What did they find? They found that approximately 8.4% of all adults studied had depression, but only 28.7% had received any depression treatment in the previous year! That means 71.3% of the people who suffer depression got no treatment for this depression.

Of those who were being treated for depression, about 30% actually had depression based on the screening, and another 22% had serious psychological distress. That means that of the people in the study who were being treated for depression roughly 48% neither suffered depression nor did they suffer serious psychological distress, indicating inaccurate diagnoses by the treating professionals.

There were some interesting correlates of depression. About eighteen percent of those in the lowest income group suffered depression, while only 3.7% of those in the highest income group suffered depression. It pays to be rich!

Depression was more common in those who were separated, divorced, widowed, or who had less than a high school education. None of this is terribly surprising.

How did depression sort out by age?

In the 18 to 34-year-old group 6.6% suffered depression. In the 35 to 49-year-old group 8.8% suffered depression. Ten percent of the 50 to 64-year-old group suffered depression. Of those over 65, only 8.3% suffered depression. So at least in this sample the 50 to 64-year-old group was slightly more likely to suffer depression, and contrary to what many people think, the youngest adults were somewhat less likely to suffer depression.

Of those who were married only 6.3% suffered depression. Of those who were separated, divorced, or widowed, 13.3% suffered depression. Divorce is bad for mental health, with almost a doubling of rates of depression.

Most of the patients who were treated for depression were treated by general practitioners (73%), with roughly 24% receiving treatment by psychiatrists and 13% receiving treatment by other mental health specialists. (There was some overlap, that’s why the numbers add up to more than 100%.)  This may explain the rather poor diagnosis and treatment of depression because general practitioners although competent and intelligent, are very busy and typically only have a few minutes to spend with each patient, not enough to do a good job diagnosing and treating depression.

CONCLUSIONS ABOUT DEPRESSION FINDINGS

What can we conclude from this research?

  1. Almost 10% of the adult population suffers from depression. Of those people who have depression less than 30% of them will get any treatment for depression.
  1. You are more likely to suffer depression if you are in the lowest income group, divorced, separated or widowed, or have no high school education. If you are married you have half the probability of being depressed.
  1. Many adults receive depression treatment even though they don’t really meet the criteria for depression. In this study, almost half of the people receiving treatment for depression were neither depressed nor were they even particularly distressed.
  1. Rates of depression by age groups were relatively equal, with the youngest age group having the least depression and the middle-aged group (50 to 64) suffering somewhat more depression. Married people are suffer half as much depression as divorced, separated, or widowed people.
  1. Most people received depression treatment from their general practitioner or internal medicine doctor, with a smaller number receiving treatment from a psychiatrist, and even a smaller number receiving treatment from psychologists. This also meant that most people who receive depression treatment were treated using medication, and very few people received psychotherapy, even though most studies comparing medication to cognitive behavioral therapy for depression have shown that therapy performs at least as well as medication and probably better over the long term, with less relapse.

Reading between the lines of this study, it suggests that many people who feel depressed would benefit from receiving an accurate diagnosis from a clinical psychologist, and might very well also benefit from receiving cognitive behavioral therapy for depression rather than medication. Even if medication is indicated, a psychologist could recommend it to the patient’s general practitioner, and then monitor more closely the results.

The study also suggests that many people receive antidepressant medication who actually are not depressed, which needlessly exposes them to side effects and also fails to provide the correct treatment for what troubles them.

And finally, since only about 30% of those who suffer depression received any treatment for it, if you feel depressed, be sure to pursue treatment for depression. Get an accurate diagnosis and then get treatment, ideally with a psychologist or therapist who practices cognitive behavioral therapy. If you want more information about depression, I’ve written extensively about it with a complete list of depression articles.

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Dr. Andrew Gottlieb is a clinical psychologist in Palo Alto, California. His practice serves the greater Silicon Valley area, including the towns of San Jose, Cupertino, Santa Clara, Sunnyvale, Mountain View, Los Altos, Menlo Park, San Carlos, Redwood City, Belmont, and San Mateo. Dr. Gottlieb specializes in treating anxiety, depression, relationship problems, OCD, and other difficulties using evidence-based Cognitive Behavioral Therapy (CBT). CBT is a modern no-drug therapy approach that is targeted, skill-based, and proven effective by many research studies. Visit his website at CambridgeTherapy.com or watch Dr. Gottlieb on YouTube. He can be reached by phone at (650) 324-2666 and email at: Dr. Gottlieb Email.

12 Techniques for Giving Criticism and Feedback so that People Can Hear It without Getting Defensive

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I was recently asked a very interesting question by one of my clients. He asked, “What percentage of people can listen to feedback and criticism without getting defensive?” I responded, not really in jest, “Only the people that have taken my non-defensiveness training!”

The reality is that most people instantly get defensive when criticized or even given mildly negative feedback. Regular readers will recall that I’ve written extensively about how to respond non-defensively: see “Radical Non-Defensiveness: The Most Important Communication Skill.”

But I also wanted to write about the other side of the equation – some techniques for giving feedback and criticism that lower the probability of the other person feeling hurt or getting defensive.

Here are 12 great concepts in giving feedback and criticism.

1. Focus on behavior and not on the person. Never label the person with a pejorative label. Avoid words like “inconsiderate”, “jerk”, “slob”, “lazy”, and all other negative label words especially four letter words.

2. Be specific and concrete when you focus on behavior. Use the journalistic technique of who, what, when, where, and if appropriate, why when you describe a behavior. For instance, consider this feedback from a wife to her husband: “An hour ago, when we were talking to Herb and Lucille, in their garden, you told them about my getting fired from my job. This upset me because I have a lot of shame right now about getting fired.” Notice that this feedback includes all of the specific descriptors.

3. Whenever possible, tell the person what you want instead of what you don’t want. So instead of criticizing your partner for sitting on the couch while you clean the kitchen, instead ask them to help you clean the kitchen. If there is a specific behavior that you would like the person to stop, it’s okay to ask them to stop but usually better to also specify something else that you would prefer. Example: “I’d really like it if you wouldn’t scream at the children. Could you instead talk firmly to them? I’d really appreciate that.”

4. Recognize what people can change and cannot change, and how difficult a specific behavior will be for them to change. This is a difficult lesson, and one that most of us resist. But it’s terribly important.

I’m reminded of the famous parable of the frog and the scorpion. In the story, a scorpion and a frog meet on the bank of a stream and the scorpion asks the frog to carry him across on its back. The frog asks, “How do I know you won’t sting me?” The scorpion says, “Because if I do, I’ll drown, and I will die too.” The frog is satisfied, and they set out, but in midstream, the scorpion stings the frog. The frog feels the sting, knows he is dying, and has just enough time to gasp “Why did you sting me, now we both will die?” Replies the scorpion: “Because I am a scorpion, it’s my nature…”

Another similar saying is, “Never try to teach a pig to sing, it will frustrate you and annoy the pig.”

Some things people can change and others are more linked to their basic character and nature, and are extremely difficult if not impossible to change. There is also the issue of what people are willing to invest energy in changing.

Here are some criteria for determining whether a particular criticism even make sense.

  • Has the person had a specific behavior for most of their life? If so, what makes you think it will suddenly change?
  • Is the person genuinely interested in making the desired change? Is it within their value system to change? People can change the things that they strongly wish to change, but if they’re only changing because you asked them to, they will most likely fail.
  • How much energy would it take for the person to change the behavior? Something that takes very little energy is more likely to happen than a request which will take herculean amounts of energy.
  • Is changing this particular behavior the most important thing for you or might there be a different behavior that would yield more satisfaction for you?
  • Does the person have shame attached to the behavior you are criticizing? If so, you should carefully consider whether the criticism is worth the pain you will most likely cause.

The idea here is to avoid asking the scorpion not to sting. If someone’s been messy and disorganized for their whole life, it’s probably not reasonable to ask them to become neat and organized. That doesn’t mean you couldn’t make any requests, but a more reasonable request might be to ask the messy person to keep their mess within a specific room or rooms, and then close the door.

Always evaluate if it’s even worth giving criticism. Remember, criticism is fairly toxic to relationships. Women sometimes criticize men in the hopes that the men will change. Nobody really changes. If you feel a need to criticize your partner constantly than the problem is probably with you and your lack of tolerance and acceptance. Or maybe you need to re-evaluate whether the relationship makes sense to continue.

5. Avoid giving feedback or criticism when you are particularly angry. Very few of us have the skills to give gentle and reasonable criticism when we are really frustrated and angry. If you give criticism when you are pissed off, you will blow it. You won’t be able to follow any of the rules in this article. Your primary goal will be to hurt the other person, which never works out well.

6. Pick your time and place carefully. This should include assessing your partner’s state of mind. If they are hungry, angry, stressed out, or tired then defer your criticism for later. It will never go well if you’re not attentive to time and place and state of mind. And remember, sometimes the right time and place is never and nowhere.

7. Ask for change, don’t demand change. Most of us get really stubborn when someone demands that we change. Besides, who made you the boss?

8. Avoid spending any significant time discussing the past. Mistakes made in the past are over and done with unless you own a time machine. Giving multiple examples of past mistakes will only overwhelm the person and make them defensive. Give only one example at most. Better yet, use an example from the current time. Assume your partner isn’t stupid and can understand the specific behavior you’re asking them to change.

9. Once you’ve asked for a change don’t micromanage that change. Let the person figure out how to do it, and don’t stand over them or constantly monitor them.

10. Be very specific about your feedback and the desired outcome. Your requested outcome should be so clear to the other person that anyone would be able to determine whether the outcome had occurred or not. Use the journalistic model of who, what, when, where, and why. Use accurate language, and avoid extremes of “never” or “always”. Don’t ask your partner to never again throw their clothing on the floor. Instead, specify that you would like it to happen less frequently.

11. Use a soft start up. Give a compliment first and be gentle in the feedback you give. Point out (if true) how the criticized behavior is a departure from the person’s usual terrific behavior. This is a way of giving a compliment while giving criticism. Example: “You are usually so helpful in the kitchen. But last night you left all of the dirty dishes. I’d really appreciate if you’d clean them up this morning.”

12. Never threaten your partner or deliver ultimatums. Even if you are at the end of your rope never threaten the termination of the relationship. When people hear an ultimatum they shut off. Also it triggers resistance since none of us like to be blackmailed into action.

Also, you can only make an ultimatum once. If you make it more than once you lose all credibility. So just avoid them entirely. (Notice this applies to parenting children as well.)

So there you have 12 great techniques for giving feedback and criticism in a healthy way. Remember that it’s essential to balance criticism with lots and lots of compliments and showing appreciation. Good relationships typically have at least a 5 to 1 ratio of positive feedback to negative feedback. If your relationship has a lower ratio than this then it’s time to change. Catch your partner doing things that you like and appreciate, and let them know in a warm and genuine way. This is perhaps the most important secret of giving criticism – let it be in the context of lots of praise.

Now I have to go tell my sweetie that she is awesome!

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Dr. Andrew Gottlieb is a clinical psychologist in Palo Alto, California. His practice serves the greater Silicon Valley area, including the towns of San Jose, Cupertino, Santa Clara, Sunnyvale, Mountain View, Los Altos, Menlo Park, San Carlos, Redwood City, Belmont, and San Mateo. Dr. Gottlieb specializes in treating anxiety, depression, relationship problems, OCD, and other difficulties using evidence-based Cognitive Behavioral Therapy (CBT). CBT is a modern no-drug therapy approach that is targeted, skill-based, and proven effective by many research studies. Visit his website at CambridgeTherapy.com or watch Dr. Gottlieb on YouTube. He can be reached by phone at (650) 324-2666 and email at: Dr. Gottlieb Email.