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Friday, January 9. 2009

Is Psychotherapy a disappearing activity?

I sent an article from Psychiatric Times (which we linked a while ago), titled The Decline of Psychotherapy, to a Psychiatric colleague. He responded "Good timing for me. It will be dead just when I am ready to retire from my psychotherapy practice."


The article says:



The number of psychiatrists who provided psychotherapy to all of their patients declined from 19.1% in 1996-1997 to 10.8% in 2004-2005. From 1996 through 2005 psychotherapy was provided in 5597 of 14,108 office visits to psychiatrists lasting longer than 30 minutes, but the percentage of visits involving psychotherapy declined from 44.4% in 1996-1997 to 28.9% in 2005-2006.



People who have never used a good shrink psychotherapist have no idea how helpful we can be, sometimes even very quickly...but sometimes not quickly at all. I wish I could offer examples, but I'm touchy about the confidentiality.

Posted by Dr. Joy Bliss in Our Essays, Psychology, and Dr. Bliss, The Culture, "Culture," Pop Culture and Recreation at 14:14 | Comments (25) | Trackbacks (0)

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I guess "good" is the key word here. I lost all trust and respect for the profession last year when the therapist I had been seeing for many years gave me one week's notice of his/her retirement and I later discovered that "retirement" was a cover for surrendering his/her license. A year later and I'm still mad over the betrayal and abandonment.
#1 gramafour on 2009-01-09 14:32 (Reply)
My father is a psychiatrist at a large university teaching hospital in London.

He requires that all his residents turn in their prescription pads as a first order of business, a real ego blow to the newly minted practitioners.

"We practice psychiatry. Before you prescribe drugs, you will learn psychiatry."

Years later, every one of his students have expressed their gratitude for his insisting that psychiatry is about more than drugs, notwithstanding the prevailing culture. Psychotropic drugs have their place to be sure, but they do not heal.

A psychiatrist, committed to providing effective psychotherapy can offer patients (no, not "clients") the opportunity to live a meaningful and productive life.

'Not a bad way to make a living,' as my dad says.
#2 Sigmund, Carl and Alfred (Link) on 2009-01-09 14:56 (Reply)
Decline? I thought everybody was in therapy these days.
#3 rightwingprof (Link) on 2009-01-09 15:23 (Reply)
Maybe they are, but less so with Psychiatrists. If I get in a mess, I'd take a grey-haired hard-nosed Psychiatrist anytime over a 20-something Social Worker who "really cares about people."
#3.1 Bird Dog on 2009-01-09 17:37 (Reply)
Ah. I should have mentioned that the therapist I was seeing was a 60-something social worker, not a Psychiatrist. Perhaps I'm being unfair to lump all therapists together.
#3.1.1 gramafour on 2009-01-09 17:56 (Reply)
Family like the Brewsters in "Arsenic and Old Lace". But happily, I'm the daughter of a sea cook! I wish....but one of this vanishing breed has been a life saver for me. Course it may take twenty years to turn me into a decent human being....

I am often snarked at here for speaking ill of family members anonymously on the net, so no point in whining to the unsympathetic. Also, one doesn't want the relatives to recognize themselves... But to get an idea, imagine the Borgias rather than the Brewsters? Mixed up with some Viking berserkers, crazed planters, the nastier French peasants in Jean de Florette, and a happy New England family like Annie Hall's crossed with Lowell, Frost, and Sylvia Plath (one of the latter in every generation but not as good poetry).... LIke Cary Grant in the old film, I fear being overcome by the family curse. So I vent to friends, real and virtual, pray a lot, then go out and battle insurance companies, hospitals and shrinks on my relatives' behalf. Better that than PC simpering about them but not getting them good care...

As far as my care goes, I'm a satisfied customer....er... patient. Despite having spent the price of a Ferrari on therapy for recurrent depression over the years. The right psychiatrist helps one focus, walk across the swaying Indiana Jones style rope footbridge to safety when all hell is exploding around one.
#4 retriever (Link) on 2009-01-09 18:05 (Reply)
I blame Woody Allen.
#5 commander clopfelter (Link) on 2009-01-09 18:08 (Reply)
I agree psychotherapy is extremely helpful when you are lucky enough to find a good and I mean"good" psychiatrist. Never really believed in the health counselors or social workers for therapy but they are good for referring patients. The problem is insurance companies won't cover enough sessions to make headway. Too bad psychiatrists and obstetricians will end up in a mauseleoum but who will deliver the babies and who will treat the head cases( no negative connotation intended as I am one of them).
#6 opie109 on 2009-01-09 18:08 (Reply)
An additional problem (and here one gets into the logical fallacies turf) is that one has to be pretty troubled to be willing to spend the kind of money a good psychiatrist costs. As Jesus said, the sick need a physician, not the healthy. Yet, even if they help one a great deal, one may still (to the critical outside world) seem a right loony, and they will say "Obviously psychotherapy is a real racket as you're no paragon of mental health." One is a bad advertisement for the service. All one can retort is "If you think I'm bad now, you should have seen what I was like before. And I don't just mean richer."
#6.1 retriever (Link) on 2009-01-09 19:44 (Reply)
Our local papers do not provide us with many opportunities for a scandal, but recently in WA there was "a problem". It appears that during the "Clinton years" there were way too many unqualified people being given certificates to practice. You will have to do some research (check Seattle Times). The gist of the story is this: some legislators realized that we had approximately 3,000 people practicing counseling and they were not trained counselors. Oh well--just complain about it being "their turn" and all is well-except of course the poor fools that don't know the difference and really need help when they go seeking it!
#7 apple pie on 2009-01-09 18:44 (Reply)
Alright, I was being facetiously serious about Woody. Or seriously facetious.

I’ve been to therapy. I went twice for a total of about four years. The results:

1. I learned that the reason for most of the debilitating anger, depression, and anxiety I had been experiencing was a complete inability to successfully perceive and deal with being wronged by others.
2. The primary cause of this condition was partly temperamental, partly having been raised by an extremely naďve mother and a narcissistic father.
3. I was on my own to figure out how to correct my situation.

That’s it. Four years with two different “professionals” who sat around listening to my confusion waiting for me to come up with my own insights which I needed to move on.

In hindsight, if I was a conscientious and competent shrink, I believe I would (should) have diagnosed this condition much more quickly and then offered multiple effective suggestions and remedies – the way a good MD, teacher or sports coach can.

I still think the business is a money scam and deserves a bad rap.
#8 commander clopfelter (Link) on 2009-01-09 18:45 (Reply)
"I wish I could offer examples, but I'm touchy about the confidentiality."

I know. We can't really write about what we know and do best. Unfortunately, that has mostly left the discussion to non-clinicians who, IMO, don't really know.

'Maybe they are, but less so with Psychiatrists. If I get in a mess, I'd take a grey-haired hard-nosed Psychiatrist anytime over a 20-something Social Worker who "really cares about people."

Boy, do I agree. Essentially, paraprofessionals are seeing most of the "clients" and, to put it bluntly, it's not a job for people who haven't thrown themselves into the profession--heart and soul--lock, stock and barrell.

When I was first getting to know Mrs. X, she asked me why I pursued such advanced academic and clinical training when I could have practiced with far less training. My genuine and immediate response was that I didn't understand why anyone would want to do this work with so little training. Don't they like the study, don't they want to really learn the discipline and perform at their best?

Clearly, my response disturbed her. As a clinician, I should have known that there is always an unspoken itch behind a question. But we were getting to know each other quickly, quite enamored with one another and having a couple of drinks at one of our favorite outdoor spots, so I wasn't my usual circumspect self.

So? She had been in therapy with an MA counselor and, after a few years treatment, left therapy with some very, justifiably, unsettling feelings about the counselor. My remark, stirred some things up for a bit of time. I'm not one to criticize anyone's therapist, present or past, but the things she described were inexcusable--malpractice really. No anonymity, dual relationships, crazy framework deviations, confidentiality violations. And that's the short list.
#9 Dr X on 2009-01-09 18:57 (Reply)
The answer is in the name.
#10 Hul Gil on 2009-01-09 20:18 (Reply)
I have some experience with psychiatry as well and I think it was useful. But deep down I attribute success to the Valium.
#11 lonetown on 2009-01-10 07:04 (Reply)
How does a psychiatrist shrink effectively beyond their personal beliefs? For instance, faith. I have two friends who were chastised by Catholic shrinks in the name of religion. I use the word 'chastise' lightly as it was more of a passionate admonishment in both cases.

There are a few on this thread who look down on social workers who go to school to become licensed therapists. "..because we care..." How many people seek out their priest, ministers, preacher for counseling? Are they as 'low-life' as the licensed therapist?

It seems to me in this "And how did that make you feel" profession, what matters is the therapist's, shrink's, minister's ability to understand the human condition and to deal intuitively with particular problems. Obviously, serious mental illness should be referred to a psychiatrist, but putting down therapists and clergy from whom you seek help is arrogant. A psychiatrist can be just as big a blockhead as a 'mere' social worker or priest who 'cares'.
`
#12 Meta on 2009-01-10 11:33 (Reply)
I would agree with that. But in my mind the best thing a shrink can do is shut the H up. For most situations, aside from keeping the patient's rambling within the asymptotes of reality (which is a problem in itself when the shrink has a "perception is reality" perception), the patient will eventually cure him/herself. They just need to be able to speak their inner thoughts and feelings out loud to another perceptibly rational thinking person whom they trust will not share the patient's private personal concerns to anyone else. This helps the patient to throw away what they do not need and to realize the importance of the ideas they do need. But most shrinks can't differentiate between what they themselves believe to be real and what is real so they have to jump in to "correct" based on their own belief system, which is either their religion or politics or (mostly) PC mentality.
#12.1 KRW on 2009-01-10 12:12 (Reply)
You guys are nuts.

How does an MD heal effectively beyond their personal beliefs?
1. They observe the condition.
2. They investigate and factor in the influence of genetics, environment and habit.
3. They compare with best-fit most-similar case histories and prescribe the solution which has worked best in those cases.
4. If the solution fails, they move to plan B.
#12.1.1 commander clopfelter (Link) on 2009-01-10 13:54 (Reply)
Provided the patient's condition hasn't been altered by plan A, in which case we must start over with a new plan A. This works out great for the "physician" though the patient may see it differently.

These issues differ from a true medical condition. I agree that some situations are truly medical in the way of chemical imbalances due to various gland malfunctions, etc. but that is a different problem space. For most psychotherapy the patient has the tools available to heal him/herself and at some level knows what needs to be done, he/she/it just needs to work out which path to take. Some psychotherapists (I'm told) understand this.

And something to Meta's point I wanted to add but lunch was calling..."priest, ministers, preacher for counseling? Are they as 'low-life' as the licensed therapist?", I've actually heard a shrink effectively answer "yes" to this rhetorical-type question. And also to Meta's good point "what matters is the therapist's, shrink's, minister's ability to understand the human condition and to deal intuitively with particular problems", I truly believe that no one should enter any of these four professions without first having had a career in the real world of success and failure so that they have the practical experience needed to understand the subtleties of perception/reality.
#12.1.1.1 KRW on 2009-01-10 15:11 (Reply)
IMO (of course), the ultimate goal should always be self-empowerment thru self-reliance, while increasing self-understanding, self-acceptance, and clarity of perception. It can be a tough, competitive world out there. But these things may be better taught by those who are skilled at such - to kick start the whole process, than magically grown at the patients own pace.

There is far too much, um... tolerance, for those “professionals” who keep their patients in a state of ‘suspended stabilization’ for their own conscious or unconscious reasons.

My nephew was on ADD drugs and specialized therapy throughout much of his childhood, as something was always “wrong with him”. But when sis finally figured out that he was simply acting out to a very bad situation at his small Christian school (she’s very religious, respects authority, has marginal self-esteem, and was thus blinded to this possibility), she realized that he was not broken. She then focused what I mentioned in the first paragraph. She achieved excellent results. She accomplished what these “professionals” would not.
#12.1.1.1.1 commander clopfelter (Link) on 2009-01-10 16:07 (Reply)
CC, I completely agree concerning the tolerance of "professionals" who keep their patients dependent upon them. Some people do need to be prodded to move but the shrink needs to restrain him/herself from providing unsolicited (or IMO even most solicited) opinion. There is not time, money, or practical ability on the patient's part to accurately convey to the shrink the patient's life and environment (we are of course speaking of mostly-functional people outside of institutions here). Only the patient knows his/her real situation, thus the need for the patient to figure out how to deal with his/her life situation themselves.
#12.1.1.1.1.1 KRW on 2009-01-10 17:22 (Reply)
Both times I saw therapists (15 years apart), I was suffering the emotional results of being targeted by Dark Triad personalities. My naiveté, depression, and lack of a good means of support ensured the cloudiness of my thought processes, and I had great difficulty in extracting myself from these situations without help. My nephew went through the exact same thing.

If I was a therapist, the second thing I’d be looking for, (first being the innate temperament of the patient), would be whether a criminal or sub-criminal violation by another was involved. IMO, most ethical therapists may be laboring under the delusion that their patient’s dysfunction is always their own fault.
#12.1.1.1.1.1.1 commander clopfelter (Link) on 2009-01-10 18:42 (Reply)
CC, It sounds as if you dealt with behaviorists. Most good 'helpers' would deal with underlying issues - such as your naivete and depression - and start from there.

The worst thing possible is to be blamed for circumstances out of your control, and even those circumstances within your control but lost temporarily because of depression, loss, etc. Time to get a new helper if that happens. Half the time we seek help is because we've become our own worst enemy. The last thing we need is to have someone we've sought for help validate that skewed thinking.
`
#12.1.1.1.1.1.1.1 Meta on 2009-01-10 20:12 (Reply)
Call me old-fashioned, but I have a father confessor. We get together about once a week. It works for me.
#13 rightwingprof (Link) on 2009-01-10 14:35 (Reply)
To my mind that is the best solution but it wont necessarily work for someone who is, say 5% atheist 35% agnostic, 45% methodist, 5% baptist, 5% catholic, 10% buddhist, and 5% confucian.
#13.1 KRW on 2009-01-10 15:17 (Reply)
Mixed nuts?

Sorry, I couldn't help it.
#13.1.1 rightwingprof (Link) on 2009-01-11 08:42 (Reply)

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