PRACTICES PRESENTLY PLAGUING MENTAL HEALTH THERAPY

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 arts?  To 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!