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  Change happens very slowly, while cutting edge techniques go untaught and ignored and outdated ineffective methods continue to be promoted.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?

THE SLEEP DEPRIVATION MYTH

One of my pet peeves has been that lack of sleep has been rewarded and celebrated in the US for decades.  It almost seems like we are in competition with each other on how little sleep we get.  Where does that perverted notion stem from?  Perhaps from our corporate or working environment, ethics, and expectations--or perhaps a left-over of our Protestant heritage?

I can still hear my church's admonitions:  "Cleanliness is next to Godliness!"  Cool.  After you clean top to bottom, you go to school, because "The Glory of God is Intelligence", then pop out babies to "give bodies to heaven's spirits", and both parents go to work because you hardly have another choice in this economy, where does providing for your family take priority?  After all, "No success can compensate for failure in the home."  (No pressure, though!)  It is no wonder why some people have trouble sleeping...

Contrary to the accolades people may received from others for sleep-deprivation, there are many studies that provide evidence that sleep-deprivation is neither  good for us, our health--nor for work productivity.

This cultural value must change is we hope to keep both our physical and mental health intact.  A person can only go so long without sleep before turning to sleep aids and stimulants to keep going and churning out work for their employers.  The costs are too great, people!  You lose your health, your sanity, and, ultimately, (and shortsightedly, because they promote this phenomenon) companies lose money, by replacing worn-out employees!  But YOU lose the most!  There is no virtue in sleep deprivation.

The following article speaks to this issue in more detail.  www.psychcentral.com
 

Insomnia Exhausts US Productivity

By Rick Nauert PhD Senior News Editor
Reviewed by John M. Grohol, Psy.D. on September 2, 2011

Have trouble sleeping at night? If so, you are not alone as new research shows that insomnia is costing the average U.S. worker 11.3 days, or $2,280 in lost productivity every year. That’s $63.2 billion for the nation as a whole; 252.7 days.

“We were shocked by the enormous impact insomnia has on the average person’s life,” said lead author Ronald C. Kessler, Ph.D.

“It’s an underappreciated problem. Americans are not missing work because of insomnia. They are still going to their jobs but accomplishing less because they’re tired. In an information-based economy, it’s difficult to find a condition that has a greater effect on productivity.”

In a national survey of nearly 7,500 employees, researchers asked participants about sleep habits and work performance, among other things.

Previous estimates have relied on smaller consumer panels and on medical and pharmacy claims databases focused on treated insomnia patients.

The researchers discovered 23.2 percent of employees report insomnia. Insomnia was found to be significantly lower (14.3 percent) among workers age 65 and older, and higher among working women (27.1 percent) than working men (19.7 percent).

Kessler said accurate estimates on the costs of insomnia in the workplace might justify the implementation of screening and treatment programs for employees.
Because insomnia is not considered an illness – the kind that results in lost days at work – employers tend to ignore its consequences, he said.

“Now that we know how much insomnia costs the American workplace, the question for employers is whether the price of intervention is worthwhile,” said Kessler, a psychiatric epidemiologist with the Department of Health Care Policy at Harvard Medical School.

“Can U.S. employers afford not to address insomnia in workplace?”
The cost of treating insomnia ranges from about $200 a year for a generic sleeping pill to up to $1,200 for behavioral therapy, according to study co-author James K. Walsh, Ph.D.

A closer review of the findings revealed that level of education appears to have some connection with insomnia:

• A lower than average insomnia prevalence among respondents with less than a high school education (19.9 percent);
• A lower than average insomnia prevalence among college graduates (21.5 percent);
• Those with a high school education (25.3 percent) or some college education (26.4 percent) showed higher rates of prevalent insomnia.

Study authors believe the findings could help direct intervention and even prevention programming among populations that show a high prevalence of insomnia.

Source: American Academy of Sleep Medicine

I guess I was one of the lucky ones who never agreed with the notion that losing sleep was ever worthwhile.  I think not getting enough sleep regularly is a kind of sickness or dysfunctional life-style.  Whenever I felt sleep deprived (and not without guilt at times, mind you, because of all the social, cultural and religious conditioning), I called in sick!  That is called sickness prevention.  ;0) Looking back, I don't regret it one bit.

One thing nice about working at a community mental health center is that they recognize mental health days.  (They would be announcing themselves as hypocrites if they didn't!)  The only snag is, as with any corporation, whether profit or nonprofit, your chances of moving up the ladder rely heavily on how many sick days you take.  I have that from the horse's mouth--my supervisor's supervisor (who asked me not to quote her, as it is against company policy!  Nice, no?  What a nest of worms...).  Therefore, in practice, they prove themselves to be hypocritical anyway!

Ever have those conflicts at work?  Let's talk.  Be anonymous, if you like--feel free!