This is another deeply liberating step. After amends have been made, there are no reasons that one has to hide from the world for past deeds. Those we have harmed and avoided out of shame have an exaggerated power over us.

Step 9 implies a readiness to accept the consequences of past behavior, which is important in developing new modes of being in the world. It is an essential step in the development of a self and other orientation to living.

When one sees the contribution that these "character defects" have made in one’s own misery, the process of projection onto other people and external events for unwanted inner states is reduced. The focus is on the self and not the faults of others. The addict can’t help but accept responsibility for his life, a crucial step on the movement towards maturity.

The presence of the word "moral" needs special consideration. When the Dr. Jeckyll/Mr. Hyde split occurs in a sex addict, the person "dissociates" and, in a manner not dissimilar to multiple personality disorder, becomes two people. The addict has his "normal" life and his "secret" life.

The Dr. Jeckyll side of the personality has one set of values, goals and beliefs, and the Mr. Hyde side has a completely different set. I understand the despair, remorse, and regret that follows an episode of acting out (when Dr. Jeckyll returns) as the realization that one has betrayed one’s own values and moral injunctions.

By Dorothy Hayden, LCSW
www.sextreatment.com

MSN reports that the new study adds to a growing body of research and practice involving technology-based treatments for depression and other mental health issues. In this case, the specific type of therapy used was cognitive behavioral therapy (CBT).

“There is a role for this, it’s exciting,” said Dr. Kathryn J. Kotrla, chairwoman and associate professor of psychiatry and behavioral science at Texas A&M Health Science Center College of Medicine. “CBT is tremendously underutilized.”

Computer-based treatment could benefit people in rural or remote areas who need psychotherapy, including traumatized veterans returning from Iraq and Afghanistan.

CBT “is proven [effective] for trauma-related issues,” said Kotrla, who is also associate dean of the Texas A&M Health Science Center College of Medicine, Round Rock campus. And providing it online means that “it’s discreet, it’s time-related. It avoids the issue of stigma,” she said.

Prescription rates for antidepressant medications have soared over the past two decades, but the number of people receiving in-person psychotherapy has declined. In addition, a good proportion of people for whom therapy is recommended never show up and half of those who do show up don’t last through to the fourth appointment.

So, “people are looking at different ways of delivering psychotherapy other than the traditional go-to-the-therapist’s-office-and-meet-for-50-minutes,” said Dr. Gregory E. Simon, co-author of the commentary and a psychiatrist and researcher with Group Health Cooperative in Seattle.

“On the far extreme are completely computerized or completely automated programs that don’t have to have a human being involved. On the other end, people may communicate with a therapist through a Web site or telephone but there’s a real live therapist there they’re communicating with.”

For this study, nearly 300 British patients with depression were randomly assigned to receive online CBT or were put on an eight-month waiting list for online CBT while they received usual care from their general practitioner.

The online therapy, which consisted of 10 weekly 55-minute sessions, essentially involved instant messages back and forth. About two-thirds of participants “showed up” for five or more sessions.

After four months of follow-up, 38 percent of patients in the CBT group recovered from depression compared with 24 percent in the control group, the study found. At eight months, recovery rates were 42 percent in the intervention group and 26 percent in the control group, the researchers found. That’s an improvement on recovery rates seen in conventional therapy.

The authors hypothesized that the heightened success rate might be due to the fact that people are writing rather than speaking their feelings and thoughts. “This approach could enhance metacognitive awareness, a term applied to changing the patient’s relationship with negative thoughts and feelings, rather than changing their belief in the content of the negative thoughts,” they wrote.

Virtual therapy sessions with a real person do not save much in costs (except for gas) and there may be a trade-off in terms of quality of communication. But the real benefits come in access and convenience, experts said.

“When you make the therapy much more convenient, people will be more likely to stick with it,” Simon said. “I don’t think anyone would argue that you don’t lose something. Communicating in person is richer and communication over phone is richer than just typing text, but balance that with convenience and the person is more likely to stick with it…You may be reaching people you wouldn’t reach otherwise.”