1 unveiling the mysteries of psychotherapy: a consumer’s guide to mental health services in...

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Unveiling the Mysteries of Psychotherapy:

A Consumer’s Guide to Mental Health Services in America

From the book by

Jeffrey K. Edwards, Ed.D.and

Anthony W. Heath, Ph.D.2006 Haworth Press

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The Point of this Workshop

• While writing our book, we found many conflicting and well documented facts that conflict with the current culture of mental health. In addition, there were many interesting asides we put into text boxes on the sides, embedded in text, and spread all around. I think these make a wonderful thought provoking workshop by themselves. So, here they are. For your enjoyment, and interest…..

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If there is one message writ large within the annals of anthropology, it is to beware the solid truths of one’s own culture. If we contrast our views with those of others, we find that what we take to be “reliable knowledge” is more properly considered a form of folklore.

Kenneth J. Gergen, (1991).

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Marty Seligman

• Two events changed the focus of psychology after World War II. The Veterans Administration provided thousands of jobs for psychologists, and the National Institute of Mental Health funded grants to research mental illness for psychologists affiliated with colleges and universities.

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Marty Seligman

• Previously, psychology was dedicated to making the lives of all people more productive and fulfilling, as well as nurturing great talents. However, at this point, instead of human potential, pathology became the primary direction of modern psychology.

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• This change allowed psychologists (and other professions) to continue their professional and financial advancement on a more equal par with psychiatrists. In the twenty-first century, the same economic drive now directs energies toward empirically validated treatments (EVTs), attempting to produce valid products and stay in the game with psychiatry. EVTs are now a common requirement for reimbursement of services.

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• Some clinicians, however, call them “paint-by-numbers” therapy, yet funding sources are already mandating their use, just as they insist on medications. As psychiatry and other medical professions labor to refine medical treatments, psychology also works to find effective and specific treatments.

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• However, this mechanistic, one-size-fits-all thinking has us believing that people are the same, and that their parts are broken or worn out. Treatment becomes medications and/or EVT therapies in most cases, instead of an individualized plan, or admittance that sometimes there are no silver bullets.

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• The Politics of Mental Health

• A common misconception is that a classification of mental disorders classifies people, when actually what are being classified are disorders that people have.

– American Psychiatric Association, Diagnostic and Statistical Manual for Mental Disorders, Fourth Edition, Text Revision Washington DC. APA, (2000). - p. xxxi

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• Something You Should Know• In DSM-IV there is no assumption that each

category of mental disorder is a completely discrete entity with absolute boundaries dividing it from other mental disorders or from no mental disorder. There is also no assumption that all individuals described as having the same mental disorder are alike in all important ways.

– American Psychiatric Association, Diagnostic and Statistical Manual for Mental Disorders, Fourth Edition, Text Revision Washington DC APA, (2000,). - p. xxxi.

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• Something You Should Know

• “Connections in the brain shape the way we think, but the flip side is also true,” says Dan Siegel of the Center for Human Development in Los Angeles. “The way you think can change your brain. When you think about it, you can understand almost every mental health problem – anxiety, depression, eating disorders, personality disorder, thinking disorders – as an issue of self-regulation.

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• Self-regulation is the balanced and integrated flow of energy and information through the major systems of the brain – brain stem, limbic circuits, neocortex, autonomic nervous system – and between one brain and another.”

– Wylie, M.S. (2004). Mindsight, Dan Siegel offers therapists an new vision of the brain. Psychotherapy Networker.

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• Research on neural nets indicated that the brain doesn’t process images of the world literally, like a camera, but rather registers experiences in patterns organized by the nervous system of the observer. Nothing is perceived directly. Everything is filtered through the mind of the observer.

– Nichol M.P., & Schwartz, R.C., (2001) p. 60).

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• Psychiatric medication should he used as part of a comprehensive plan of treatment, with ongoing medical assessment and, in most cases, individual and/or family psychotherapy.

– American Academy of Child and Adolescent Psychiatry, (2004).

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• Politics of Mental Health

• When therapy succeeds, the convention is to attribute the positive outcome to the therapy or ministrations of the therapist. In contrast, when therapy goes awry, or at least yields disappointing results, it has been customary to place the failure in the client or the client’s personality.

– Hubble, Duncan, & Miller, 1999, p. 47.

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• The disease model concentrates on a narrow range of “diseases,” those that fall comfortably into the physician and medication realm, and it ignores other, even more harmful states. – Martin E.P. Seligman, 2001

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• Violence, for example, is not considered a “mental disorder,” but I expect that more lives are ruined annually by it in the United States than by depression. And why aren’t bad marriages, cowardice, explosive anger, dishonesty, lack of work ethic, and the like the focus of more federal prevention efforts? – Martin E. P. Seligman, 2001, p. 2.

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• All [family therapy] models view flexibility as essential to healthy family functioning.

– Froma Walsh, 2003. p. 40.

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• I do not believe that you should devote overly much effort to correcting your weaknesses. Rather, I believe that the highest success in living and the deepest emotional satisfaction comes from building and using your signature strengths.

– Martin Seligman, 2002, p. xxx.

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• Something You Should Know• Solution Focused therapists and authors Jane

Peller and John Walters recall the time when Chicago Cubs manager Jim Fry was approached by a pitcher in a slump. He told Fry that he was going to go home and look at tapes of himself when he was pitching poorly, in order to correct his problem. Fry replied that he wanted him to only watch tapes of his pitching when he was pitching well. He did not want him to watch his poor performances, only his good ones. Makes sense! – Walter, J.L., & Peller, J.E. (1992).

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• Nearly two-thirds of all people with diagnosable mental disorders do not seek treatment.

– (Regier et al., 1993; Kessler et al., 1996, both as found in U.S. Department of Mental Health: A Report of the Surgeon General, 1999).

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• A theory is just a model of the universe, or a restricted part of it, and a set of rules that relate quantities in the model to observations that we make. It exists only in our minds and does not have any other reality (whatever that might mean).

– Steven Hawkins, A Brief History of Time, 1996.

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• Politics of Mental Health• Despite fifty years of research, the invention of

electron microscopy, the advent of radiolabeling techniques, the revolution of molecular biology, and the merger of computers with neuroimaging machines, no reliable biological marker has ever emerged as the definitive cause of any psychiatric ‘disease.” What many fail to appreciate is the biochemical imbalances and other so-called functional mind diseases remain the only territory in medicine where diagnoses are permitted without a single confirmatory test of underlying pathology.– Duncan, Miller and Sparks (2004), p.167.

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• Politics of Mental Health• In the last fifteen years, HMO’s, insurers,

pharmaceutical companies, hospital corporations, physicians, and other segments of the industry contributed $479 million to political campaigns – more than the energy industry ($315 million), commercial banks ($133 million), and big tobacco ($52 million). More telling is how much the health care industry spends on lobbying. It invests more than any other industry except one, according to the nonpartisan Center for Responsive Politics. From 1997 to 2000, the most recent year for which complete data is available, the industry spent $734 million lobbying Congress and the executive branch. – Barlett & Steele, (2004). Critical Condition.

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• The Politics of Mental Health• Mental Health? Mental Illness? Behavioral

Health? Psychiatric Services? Crazy? There are many different names for services related to emotional and behavioral problems. The insurance world uses the term “Behavioral Health.” The reasons for this are unknown. We do know that this term refers to all types of human problems that are not obviously due to physical problems. This includes problems that have to do with behavior and problems related to feelings.

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• Something You Should Know• NCQA: the Conscience of Managed Care• The National Committee of Quality

Assurance is an independent non-profit organization that sets quality standards that shape the health insurance industry. By providing a variety of accreditation products and a standard set of healthcare data, the NCQA helps the public decide which healthplans offer the best services and care.

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• Balance Billing: A Dirty Trick

• Mental health providers and hospitals contract with insurance companies to provide their services for a pre-set cost that is less than the going rate. According to the contract, these providers cannot bill the patients for the difference. If a provider tries to “balance bill” you, let your health insurance company know.

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• The Politics of Mental Health

• Some 15% to 22% of children have mental health problems that justify psychotherapy, but fewer than 20% of these children receive treatment.

– Tuma, 1989.

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• The Politics of Mental Health• Everyone knows the basic statistics: Forty-four

million Americans have no health insurance. That’s equal to the combined populations of Massachusetts, Alabama, Oregon, Iowa, Connecticut, Mississippi, Vermont, Arkansas, West Virginia, Montana, Louisiana, Indiana, Maine, and Nebraska. Fourteen states in all--- every man, woman, and child off the heath care books. No other industrialized country would tolerate this. And the number of the uninsured keeps right on growing, along with the population.

– Barlett & Steele (2004). Critical Condition.

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• The Politics of Mental Health• What’s in a Name? Psychotherapy?

Counseling? Therapy? Counselor? Therapist? In this section, we use the fancy term psychotherapy to include mental health-related therapy and counseling. In our opinion, the differences among these words are differences among words, only. The same can be said for therapist and counselor. While state licenses restrict use of certain terms or titles, where talk therapy is concerned, almost everyone speaks the same language.

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• Kingdoms rise, and kingdoms fall, but you go on.

• U2, 1981.

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• The field of mental health has long neglected the study and promotion of health. In the concentration on mental illness, family normality became equated with the absence of symptoms, a situation rarely, if ever, seen in the clinical setting.

– Froma Walsh, 2003. p. 27

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• One simply moves in the direction of accepting one’s self more and more completely. Then in the process of this acceptance, sanity simply begins to emerge. – Gerald May, M.D., 1990.p. 103.

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• The mortal wound of psychotherapy occurred when it made objects-to-be-fixed of the people it was trying to help.

– Gerald May, M. D. (1990) p. 62.

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• We view clients as partners with their therapists in the sense that they are involved as fully as possible in each aspect of their therapy.

– Corey, Corey and Callanan,(2003) p. 151.

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• Always laugh when you can. It is cheap medicine.– Lord Byron

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• Man has never made any material as resilient as the human spirit.– Bernard Williams

• There is more than one way to skin a cat.– Old Folk Wisdom

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• That’s all. Hope you enjoyed this as much as I did writing it.

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• Buy our new book at: Click here: The Haworth Press Online Catalog: Product: 'A Consumer's Guide to Mental Health Services'

http://www.haworthpress.com/store/product.asp?sid=QCKJUL81DGWA8GQ80D24KKRFQ4R2EFG6&sku=5838&detail=Contents

