September 24, 2013
My friend and colleague, Mike Plaut, has another paper out (actually it’s still in press) in the Journal of Health Care Law and Policy. Mike’s writing is great – almost conversational – so I always enjoy reading his stuff. In this paper he describes the work he’s been doing for years at the University of Maryland’s Medical School with health care professionals who act out sexually with patients. Similar to the work I do with disruptive professionals, Mike works individually with physicians and other providers rather than working with groups, and he tailors his interventions to the individual. Now, in contrast to most of my work, Mike holds tighter to the role of the academic advisor than therapist or even coach, as he guides the professional through the relevant literature and has them write a paper about the reason for their referral to him. I typically blur the boundary between coach and therapist as I believe there are more similarities between remedial coaching and psychotherapy than differences, and I have found this to be an invaluable approach to my work with physicians, psychologists, nurses, other healthcare providers and other professionals who have gotten themselves into hot water at work, usually because of interpersonal problems.
September 13, 2013
Yet another article was published recently that touted the positive effects of psychotherapy. In this study the authors noted that psychotherapy was as effective as antidepressant medication at treating and preventing relapses of depressive episodes. Of course the side effects from psychotherapy are much less than those from medication, which is nice. But what made this article special was that it was published in JAMA Psychiatry. Yup, one of the best professional publications for psychiatrists said that medications are not better that psychotherapy. This is great for several reasons. First and foremost, it’s a wonderful demonstration that the ever-increasingly medicalized field of psychiatry is willing to acknowledge the benefits of non-medical approaches. Of course the content of the article is great too; there are many people who cannot tolerate psychiatric medications or simply do not want to use medicine to treat their psychological issues, and this (and many other) article(s) supports these individuals in not caving in to popping a pill to rid themselves of psychological pain. Now, please don’t get me wrong… in no way am I opposed to appropriate use of psychiatric medication. However, I am very frequently disappointed by medical professionals who prescribe antidepressants, sleep aids and antianxiety medications without considering empirically validated better options first or at least in conjunction with the medications.
June 10, 2013
I just came across a recent article in the AMA’s newsletter, AMedNews.com, about physician (and staff) burnout. Nothing all that new here, but it talks about how overwork and burnout of one member of the treatment team or office staff – - physician or non-physician – - affects the productivity, engagement and satisfaction of others in the office. Many of the physicians and other healthcare workers who come to see me for therapy or coaching suffer from burnout. This tends to be particularly troubling for those professionals who are highly specialized in their training and expertise as they often feel that there are no other options but to continue in their current mode of practice, leaving them to feel trapped. Burnout is relatively easily dealt with once the problem is identified and the professional invests her/his attention and time to the matter of resolving the situation.
October 17, 2012
The American Psychological Association (APA) recently launched a new awareness initiative about the benefits of psychotherapy. There are a couple cute videos (below) that mock the pharmaceutical commercials that we see too often. Though I very much appreciate this approach, I do not fully agree with the claim that psychotherapy has no negative side effects. I can’t think of anything we can ingest, be exposed to or do that doesn’t have some side effects; for example everything we do comes at the expense of something else that we otherwise could have done. I speak often about “compromise formation” with my patients and consulting clients, and with this concept, I believe firmly that psychotherapy does have side effects, but that they are almost always “worth it” from a cost-benefit analysis perspective.
Enjoy the videos…
January 10, 2012
Tomorrow the American Psychological Association (APA) releases the results from their annual “Stress in America” study. As part of the release of their findings, they will be holding a webcast tomorrow (Wed, 1/11/12 at 4:30pm EST) that is open to all. You can register online. For more information, go to APA’s Stress in America page.
October 31, 2011
I have to admit that though I receive The American Psychologist (the main journal of the APA) monthly, I rarely get through more than one article per issue because the articles are so dense. This month, there was a great article about Lifestyle and Mental Health. What I loved about this article is that there was nothing all that radical in it; it simply listed dozens and dozens of published articles that support the association between improved mental and physical health with exercise, nutrition and diet, time in nature, relationships, recreation, relaxation and stress management, religious or spiritual involvement and service to others.
These “lifestyle” issues are all things that I have been talking about with my patients in therapy for years. This article simply provides a wonderful review of the scientific literature that supports these lifestyle changes. Take a moment and read through the article. Hopefully it’ll inspire you to make a few lifestyle changes of your own.
October 20, 2011
The CDC just put out a report about Americans’ use of antidepressants. The paper has already gotten a bunch of press (Washington Post, CNN, Reuters to name a few). Some of the key bullet points of the paper are:
- Eleven percent of Americans aged 12 years and over take antidepressant medication.
- Females are more likely to take antidepressants than are males, and non-Hispanic white persons are more likely to take antidepressants than are non-Hispanic black and Mexican-American persons.
- About one-third of persons with severe depressive symptoms take antidepressant medication.
- More than 60% of Americans taking antidepressant medication have taken it for 2 years or longer, with 14% having taken the medication for 10 years or more.
- Less than one-third of Americans taking one antidepressant medication and less than one-half of those taking multiple antidepressants have seen a mental health professional in the past year.
Wow, that’s a lot of info to digest, but a couple points stand out for me: 1) only one third of severely depressed people take antidepressants, and 2) less than one third of people taking antidepressants have seen a psychologist, psychiatrist or social worker. What this means is that the people who most need antidepressant medication are not taking any, and most people who are taking such medication don’t access services that can either replace, or serve as adjunctive treatment to, the antidepressant medication they are already taking.
October 18, 2011
The Wall Street Journal just ran a nice little piece on how to go about choosing the right therapist. I love seeing articles like this in publications like that. The article noted there are different types of therapists, therapies, etc and that what works for one person might not work for the next.
I loved that the author suggested becoming an informed consumer when seeing psychotherapy, but readers should know that some of the suggestion questions are not always answerable. For example, it is perfectly appropriate to ask a therapist about his training or her experience in working with your particular symptoms. It is also quite reasonable to ask about the proposed treatment approach, duration of treatment, etc. However some of these questions cannot be answered definitively after just one session. For example, new patients to my practice often ask, at the end of the initial consultation, how long will therapy take. I explain that I really can’t answer that question with much confidence because there are simply too many variables – - known and unknown variables – - that will affect the duration of our work together.
I add that there are some folks I work with for just a handful of sessions and that is all they need to achieve their desired goals, and there are other people who I have worked with for several years. A key element within longer-term treatment is regularly circling back throughout the therapeutic process and reassessing if it is still appropriate to continue treatment; I would never want to work with a patient (and charge him or her, of course, for services rendered) and have the treatment not be of significant benefit. Ethically, any good psychologist would terminate treatment if s/he feels it is no longer of benefit to the patient.
September 15, 2011
Time Magazine ran an interview style article with a recent president of APA that, in my opinion, demonstrated a horribly misguided understanding of psychotherapy. The piece starts out by addressing a very real and complex set of public health problems: there are many people in need of psychological treatment that don’t have access; there is confusion about what works in psychotherapy (and why); there are quacks out there treating patients without adequate training and supervision; etc. However the quality of the article quickly slides out of control with bizarre misrepresentations of psychotherapy efficacy literature, personal opinions stated as fact and other unsubstantiated claims about the benefits of psychotherapy.
I feel it was irresponsible of Time Magazine to run such a piece without a balanced perspective, without interviewing someone more familiar with or who has more in-depth understand of the psychotherapy efficacy literature.
June 2, 2011
Though the info isn’t new, it’s just as relevant as it was years ago…
Back in 1995 Consumer Reports published an article that touted the benefits of psychotherapy. The article offered several interesting conclusions: 1) patients benefited very substantially from psychotherapy, 2) long-term treatment did considerably better than short-term treatment, and 3) a combination of psychotherapy with medication did not differ in effectiveness from psychotherapy alone.
There were other interesting findings, including that no one modality of psychotherapy was better than any other, and that licensed, doctoral level mental health professionals were more effective than “marriage counselors” or being followed just by one’s primary care physician. Furthermore, when insurance companies interfered by determining the therapists to be used or determining the length of treatment, patients did worse.
Though this was not exactly a prime example of a peer-reviewed, randomized controlled trial measuring the efficacy of psychotherapy, it was a nice, easy to understand adjunct to the existing psychotherapy effectiveness literature.