Friday, April 20, 2012


The following is a discussion/rant about educational requirements and other serious issues presently plaguing the field of mental health.
PHILOSOPHY, PSYCHOLOGY, AND RELIGION:  Is training in these fields necessary for ultimate results in therapy?  The concepts of philosophy, psychology and religion are closely intertwined.  If broken into segments, the encompassing “picture” of mental health is lost.

For example, the philosophical concept of dualism vs. monism brings us into the realm of religion.  Therefore, the type of approach or modality used are more effective when reflecting clients' belief systems.   How much do peoples' beliefs in “good” and “evil” affect their decisions and their moods?  How do these belief systems affect cognition and, therefore, the emotional lives of people?

Understanding the worldviews of clients opens doors to therapists' understanding of clients' philosophies of life.  Simply put, the more therapists know about their clients, the greater the potential to help them.

I believe a truly effective healer, it helps so much to be educated in at least two of these three fields. However, this kind of academic discipline is rarely required of students studying to be therapists.  Therefore, their effectiveness is often limited (except in rare cases where the client is exceptionally astute, intelligent, and committed to their own continuing research and education.)

Clients' beliefs regarding philosophy, psychology, and religion helps determine the type of approach used in therapy.  In other words, the theories and methods employed would be those therapists decide are most effective for the particular client.

So how effective can therapists truly be without an education in the liberal artsTo be a truly competent therapist, I believe (with some reservations), a person may need to be as disciplined and educated as a medical doctor.  (How often does that happen?)  

A common belief is that, in psychology we aren’t dealing with the nuts and bolts of body parts and instruments and, therefore, do not directly impact life and death. However, within the realm of the mental and spiritual life of clients, the therapist can be effective in enhancing the quality of life and even in helping to prevent early death and suicide.  Considering this, appropriate therapeutic methods and qualified therapists seem indispensable!

Some therapists appear naturally intelligent and emotionally in tune with others' emotions.  They seem to have incredible instincts when it comes to what to say and do with a particular client.  They seem to have a natural talent.  Yet, without adequate education, I still believe even the most intuitive therapist is at a disadvantage.  

In providing effective therapy, counselors need to ask themselves a number of critical questions.  For example, how does providing therapy affect clinicians' emotions?  (Consider burn-out.)  Can they effectively manage their involvement with others?  Can they keep their boundaries?  Have they learned tools, backed by good research that are most effective in particular cases?  Can they conceptualize their clients' cases more fully due to their additional training in philosophy and/or religion?

Being a therapist is one of the most difficult professions. Considering the financial aspects alone, even if students are minimally trained, the cost of education is daunting and can be at par with training medical students.  

Medical doctors are usually paid well (partly because of the AMA’s artificially limiting the number of doctors allowed to practice and other unsavory practices).  The therapist, in most cases, is ubiquitous and underpaid, and that is anathema considering that they are involved in the delicate process of helping heal human minds and souls.

There are many therapists who do the minimum and who are relegated mostly to social work activities within their community mental health centers.  That is a sad truth.  However, in all fairness, this truth extends to most fields of endeavor.  It is like a continuum, with the least capable, unlucky, or unwilling at one end of the continuum and the brightest, most committed, lucky, political, educated and driven at the other.  

There are, however, exceptions:  bright, committed, motivated therapists who are unwilling to cave into the political expectations of a mental health organization.  There are those who are not willing to bend on ethics, as well.  I guess those therapists go into private practice.

While good and stimulating opportunities for medical doctors are many, therapists’ chances of finding fulfilling work where they can be maximally effective are minimal.  LPC’s and MFT’s are a dime a dozen.  They are usually the last resort of choice when hiring at community mental health centers, licensed clinical social workers (LCSW’s) being preferred.  Even though the state examinations for licensing are the same, the real work and expertise required for therapy differs greatly from social work.

A community health center is a bureaucracy.  That means lots of red tape.  That means lots of paperwork.  That means lots of involvement with other agencies.  That often means money shortages.  

Most therapists’ time (regardless of titles) is spent dealing with these areas.  Can they still be effective in therapy?  Yes and no.  

Those who have enough time and energy to do so, those who are willing to sacrifice personal beliefs, conform, and are capable of working within very political environments seem to be the ones who are most "successful" at their jobs. It also helps to have flexible values.

At least, therapists are usually able to give much-needed, minimal band-aids on clients' issues.  However, the price therapists pay is often the sacrifice of their personal value systems, significant frustration with organizational politics, dissatisfaction with low-success rates, and paying for their own books and tools, often resulting in career apathy and early burnout.

If clients' issues are minimal, the help they receive is often perceived as great.  However, most clients who frequent MHC's (mental health centers) have grave and complicated issues that most therapists are inadequately trained to deal with.  This situation easily inflates the actual good MHC's do.
Another issue is that poorly supervised trainees and interns are often pressed into giving therapy they are not qualified to give, increasing the likelihood of poor quality therapy. Those issues, combined with time constraints (allowing only 6-8 or 8-12 sessions, which is usual), can only serve to scratch the surface of the clients' issues.  If clients are lucky, the therapeutic band-aid is applied, and they generally feel temporarily relieved.

Most clients have additional frustrations with the time limits of sessions (45-60 minutes) and the general structure and artificial nature of conducting therapy in offices with their therapists. The hassles and costs of keeping appointments put an additional strain on clients struggling with just getting through the day.

The effectiveness of therapy depends heavily on the therapist developing a good relationship with the client.  It is estimated that 30-50% of effectiveness depends on this aspect of therapy.  However, trying to establish this kind of relationship in so few sessions is a challenge for even the best therapists.  To complicate matters, many clients have serious trust issues; therefore, more sessions are needed to establish that kind of trust.

To sum up, lack of education, proper training, and time with clients, the structures and constraints of MHC's, and the high cost of education severely limits therapists' effectiveness for those who suffer from mental illness.  

It is past time when society needs to throw out their prejudices about mental illness and therapy and place it on par with medical help, giving therapists and therapy students at least the same level of support.  After all, considering the mind/body connection is crucial to effective therapy.  Poor physical health is often caused by poor mental health and vice versa, either directly (e.g. by self-medicating) or indirectly (e.g. by depression and loss of hope).
I ask out of frustration, how long will it take before the stigma of mental health abates?  How long before enough money is available to set up effective mental health centers?  

How long before the majority of educational institutions incorporate and require a more thorough, well-rounded education for its mental health practitioner students and train them adequately, thereby treating clients ethically and effectively?
Are you familiar with any of these issues?  Have you ever struggled with the mental health system and the level of therapists expertise?  I am very interested to hear about it.  Please blog your experiences, and share any ideas for improvement in the field of mental health.
Thank you!


Kevin said...

Several years ago the son of a friend committed suicide after a psychiatrist or therapist told him and his parents that his drug use had permanently handicapped him. I have often thought it an abrasive thing to say, which may have nudged him towards suicide. Of course, I don’t know the context of the message so my interpretation may be less than accurate but I would think a psychological obligation of mental health would be to offer hope (curbed within the scope of social responsibility).

On the other end of the spectrum, mind-body healing is popular with clinicians and I am a little skeptical. They offer Reiki classes to nurses at the local hospital and nursing students at the local community college can take Reiki classes for credit. My problem with mind-body medicine is that it works by the placebo effect, which can produce significant effects but presents an ethical paradox in the sense of whether or not you tell someone that their pain pill is really sugar. And, of course, you can’t for it to work or you get a nocebo effect. But I assume that the ethical paradox isn’t a concern for many nurses taking courses in Reiki as they simply receive training in an esoteric e eastern healing philosophy without the complimentary neuroscience of placebo course—thus, they are believers themselves.

My response to your post is that mental health is very complex. I’m sure many advocates will disagree with my characterization of mind-body medicine but it is a characterization that demonstrates a range of mental, physical, and moral complexity behind “solutions.” Optimism is surely better than pessimism but left unchecked it may pose equally ethical dilemmas. I don’t think the answers are easy and therefore I agree that a well-rounded education should be part of the repertoire of mental health professionals.

PSACHNO said...

"...nocebo effect"? hahahah...that's a good one!

Thanks so much for sharing your experience and opinions with us, Kevin. You always contribute interesting and valuable information.

Yes, it is such a complex field--a real challenge. We've come a long way, but we still have a long way to go, hey?

I don't much about Reiki, but I understand your point about practices that have not been adequately researched. On the other hand, there is so little we can "prove" at present, if we only proceed with established treatment methods, we limit not only harm but also help. It is a razor's edge to walk. And therapists too often feel perplexed about treatment with clients.

It is good you brought up not only the mental and physical, but also the moral and ethical aspects of treatment.

When my mother-in-law was dying of cancer, NO ONE told her. (It is common practice to "spare" the patient like that.) I used to think that that was barbaric and wrong. However, I now believe that, depending on the person, positive effects can result through deception.

The line between "sparing" patients/clients and involving them in their own care is so difficult to determine, however. That's why we therapists need time to understand clients--time that is too often not allotted to them both.

Unless there is some urgency in treatment, I usually waited until clients asked questions before telling them something negative. I figured, if they are ready to ask, they are probably ready to receive more accurate answers--in other words, "to tell the truth".

I am like you. The only answer I have at this point is: get more education. Knowledge is power!

Yun Yi said...

very interesting thoughts!i love all the fields your mentioned but i never had luck to make myself academically educated in these fields! so, from my sour grape perspective, i would say, it is not entirely necessary (to be academically educated).
after all these years struggle in real life, i started to trust intuition more than knowledge. i think one can approach philosophy and religion by her/himself (self study). it is my belief that it is all most impossible for one to have all detail knowledge (in the fields you mentioned), but intuition can capture a large pictures of all, which is more important than detail systematic knowledge.
well, again, you can take my remark as "sour grape" statement.:-)

Yun Yi said...

it is my belief that it is almost impossible...

Yun Yi said...

edit (sorry i just changed my mind):
it's possible for one to have all detail knowledge (in the fields you mentioned), but it's not necessary...

PSACHNO said...

Thanks so much for your comments, Yi. You bring up a point that has troubled me, especially since I wrote this post--and you've made me think!

Is it realistic to expect more education? Do I believe in a humanities education because I have one?

Therapists have helped many people; however, if they had more education, they could increase those numbers. That is my logic.

I considered which field was most geared to the human condition and, it seemed to me that humanities (which encompasses languages--we are much in need of therapists who speak certain languages, history, art, culture, music and philosophy) provided a good starting point.

I am sure that this education could be accomplished in several ways. An extra year could be added to the master's program if a candidate doesn't have the bachelor prerequisites.

Ultimately, I would rather have a therapist whose intuition is tops but whose schooling was lacking than vice versa. I think you make a valid point.

However, what is intuition? Perhaps it is just the accumulation of knowledge and experience expressed through the subconscious mind?

Is extra training and education necessary in all cases? Of course not, just as a person doesn't need a M.D. to apply a band-aid, they can also offer many kinds of "therapeutic" help without specialized training and education.

However, if we want to improve on the current system, at the very least we need much more training and education. It doesn't matter how good therapists' intuitions are, if they are not educated to deal with bonafide mental illnesses. The edict "do no harm" is endangered.

Yun Yi said...

i think we both right. while more education can help one to have a broader view on humanity, intuition can help one to handle each different individual case better. i agree that more education probably would benefit more psychologists, since only minority people possess that kind of intuition which can surpass education.

Steph said...

I know I'm johnny come late to the discussion but I think helping people garner hope with a spiritual specialty, some therapist could offer to those who seek it through what ever form spirituality manifest for the individual. Some people may want to have therapy modalities integrated with their spiritual beliefs. And education could come when therapist decide they need additional training for the specialty of offering the spiritual component. But, clients are not that savvy about the three components being beneficial to healing yet. Cutting edge stuff. In terms of the pay and importance of soul healer I agree 100%. I think due to the science of the brain is still under funded and under researched the brain is still vastly under used and its capabilities, coupled with public not knowing the place and organ that we heal, liken therapist to the medicine men of the old America west, riding our medicine wagons and peddling our potions of healing. People and some therapist don't know why what we do in fact does heal.

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