Thursday, September 22, 2011

RESPONSE TO ALAN KAZDIN ARTICLE IN TIME MAGAZINE

I applaud Kazdin for bringing out issues in mental health care.  I don't agree with Kazdin on all his assertions, however I believe he brings up some very valid issues.

I am very open to trying something better than what we have now!  After having worked at four mental health programs, I can attest that this field desperately needs improvement!

In addition, I agree that people who need care are not getting it!  First, who can afford it?  Most insurance companies don't cover mental health treatment.  (Anyway, the issue of adequate insurance coverage in this country adds another fly to the ointment.)

Second, we don't have enough good practitioners/clinicians.  Do we need more therapists?  Yes!  But they also need places to work to get certified--and those options are pathetically few.

In addition, most places do not pay interns.  After the cost of tuition, how can they survive another 2 yrs. minimum without a paycheck?  They would have to (and usually do) work another full-time job and do either full-time interning (It's crazy, but some do it!  I doubt they can do justice to their craft, however.) or part-time, in which case it takes even more years working virtually as slave labor to certify for licensure.

The cost of education is prohibitive in so many cases today!  It is a great crime against our society.  Sure, you can take out government loans, but then most students become a slave to debt--for many, many years!

There are not enough placements in cheaper state universities, and the alternative private schools are outrageously expensive.  We are so used to taking out loans and living on credit, we often take it as a matter of course.  However, this type of financing is fraught with potholes.

Besides,  state universities are under control of the state. Professors are prohibited from teaching anything that is not within the guidelines of the university.  Change happens very slowly, while cutting edge techniques go untaught and ignored and outdated ineffective methods continue to be promoted.  It is very easy to by-pass truth in education these days.

I also believe that the quality of education in the field of psychology is inadequate at most universities.  However, implementing more classwork, more instructors, more effective ways teaching the delivery of therapy makes education more costly.  The issue of getting good therapy seems to be a vicious cycle.

I agree there is not enough emphasis or money funneled into mental health care.  As a society, we are still burdened with prejudices against mental health issues and care.  Yet, I would want to be sure what the "money strings" entailed.  (And there are almost always strings!)  I would want to know from where the money really comes--and what is the REAL price to pay.  Are there ulterior motives behind the money givers?  If so, what are they?

This professor is pushing for evidence-based treatments which sounds sensible enough.  However, if you investigate what that means, you will see that evidence-based treatments are hard to come by.  Why?  Because you can only judge progress on observable behavior.

Then there is the sticky manipulative statistics factor to consider.  Are statistics accurate?  Are the methods of research sound?  You would be surprised to find out how many are NOT!


There is also the great difficulty and cost of follow up care and feedback over time to help determine what methods are useful or not.  Unfortunately, the most difficult solution is the best solution in determining best practices in therapy.

 
Lately, behavioral and, especially, cognitive behavioral are highly touted.  One reason for this is because they are behavioral approaches--and behavior can be observed and measured.  Progress has been made in this area of treatment.  Very well; I agree.

But what about other methods of therapy:  Existential, Humanistic, Brief Dynamic Psychoanalytic, Brief, Family, Gestalt,  Adlerian, and other therapeutic models?  Should we just toss them away because it is difficult to prove the success of these therapies?  That sounds wrong to me.  Yes, we need a better way of divining what works about these therapies.  However, in doing so, we again run into the problem of financing.

I believe in educating the public.

I believe on-line therapy can be a START to therapeutic help.

However, minimizing the impact of one-to-one personal relationship with a therapist who is a good fit should not be underrated!  There are significant studies/reports from clients that their relationship with their therapist accounted for about 30-50% of the efficacy of their treatment.  Shall we just throw that personalized technique away?  I am concerned that we might be headed toward dehumanizing (even more) the process of psychotherapy!

It is very difficult to find ways to improve the field without using some controls.  However, controls are part of the problem in administering effective therapy.  The more we institutionalize therapy, the less we will be able to meet the needs of people who are so individual and unique. 

Tailoring therapy is vital!  But it takes much time and experience to do this well.  Yes, I agree there are problems here.  Declaring that you are "eclectic" is passe' and, too often, an easy way to avoid being pinned down or cover up that you do not understand well enough the various therapeutic models.

Another point Kazdin considers is reading self-help books.  He makes a good point.  However, I have so much personal and anecdotal evidence that self-help books can be a great boon to us.  It would be better to educate the public on the best books out there.  Bibliotherapy is a wonderful source of information and insight, if the right client reads the right book.  Reading books can also accelerate progress in therapy.  (I hope he is not suggesting that we try controlling what is written now, as well?)

Beware.  Any policies, rules, laws that use control need to be carefully examined.  There is such a fine line between governing and administrating good care and unnecessary controls.  We already are losing our civil liberties.  We are already at risk of greater control by the powerful elite.  (George Orwell was right.  Social engineering is a reality!)  In establishing changes, this risk must be carefully considered.

Ultimately, PREVENTION AND EDUCATION of mental health issues is best!  But that is fodder for another post...
 
SEE POST:  IMPROVING THERAPY?

2 comments:

DOitTUTit said...

I've done a variety of different types of therapy. None of them were very helpful until I found a positive psychologist who helped me work through my issues in nearly the same way as all the others. Finally there was never such a negative feeling in the air where with other therapists I was getting the energy of sympathy which made me feel stuck in the situation I was in. While positive psychology made me feel empowered to be in control of the way I experienced the situations.

PSACHNO said...

It is interesting to hear about your therapy experiences.

Positive psychology is gaining strength in popularity. My personal opinion is that, because Life Coaches are so much more positive with their clients, and the field of therapy was losing some of the clients to Life Coaching, well, they had to do something!

Some therapists don't really know the difference between empathy and sympathy, often keeping the client feeling like a victim. It really is an art to know what to express empathy to a particular clients--they're all different!

I'm so glad to hear that you had positive experiences in therapy. When you find the right fit, the right therapist, sometimes it feels like the most important improvement in your life, I think.

Thanks so much for sharing this experience!