Most problems in life can be imagined to behave like a hill. That is a raised ground that presents an obstacle to you. Now in presenting this type of thinking it helps the metaphor to think of the solution to these problems as a nice warm bath of clean fresh water at the top of the hill. All you have to do is get there.
Now obviously some hills have varying levels of steepness, varying levels of height, and varying levels of traction.
Social anxiety disorder can be likened to a marble hill of >60 degree incline. It's easy to climb a few feet and then lose your traction and slide back down to the ground. In this way it can certainly feel discouraging to pursue treatment.
But the good news is that the hill is not necessarily symmetric. There are steeper but more promising paths towards treatment. I've found that this truth can be extended to many other problems in life, that a direct path - though causing more severe pain will get you to your solution faster and with many times more success than trying to go around the hill or taking varying paths to get there.
CBT is that direct path, and though it entails a lot of hard work, if executed properly, can get you the relief you need.
Sunday, January 23, 2011
Sunday, January 16, 2011
What's wrong with mental health in America.
There is a large disconnect from the promising realities of what we read in scientific studies on mental health and well the real world.
CBT is a viable treatment option if it is being practiced by an extremely well experienced and wise practitioner with adequate access to resources such as volunteer people to use in exposure sessions. The wide array of psychologists/PhD in the private practice are so alarmingly underskilled, inexperienced, and full of utter BS that it's not only not helpful to see them, it's HURTFUL to with each sessions charging 200+ dollars?
Seriously? These the people who come down the ladder of liberal arts colleges presumably under the false philosophy of being liberal philanthropists, but it seems in reality they have no qualms indulging the more "pragmatic" aspect of communist philosophy i.e. some people are more equal than others.
I've done the searches in private practice and without exception to all those who claimed under the never ending list of skills to be "CBT experts" were nothing more than pseudo intellectuals who haven't cracked open a recent study of CBT let alone a textbook or any source of information on the subject since they passed their qualifier in graduate school if they even looked at it then. They instead seem to uniformly rally around their own crackpot theories as to how the ole' noggin works and are ever so satisfied implementing their own unscientific "intensive" talk therapy treatments that I wouldn't mind betting my entire valued worth do nothing to alleviate the symptoms of clinical anxiety disorders.
I've been lucky to go into a research clinic at a university, and I know what it takes to make progress in treating social anxiety through this method, and I know that it takes intense commitment and ability to withstand intense pain.
From this learning experience, I know that the vast majority of people who read the CBT studies and think all it takes is a quick call to get on board a program to change their lives are deluding themselves. For one thing, if you call any mental health practitioner in this country - go ahead - you'll find that ~80% aren't accepting new patients and those that are have a >20 day waiting list before you can be accepted.
Just being accepted to see a qualified mental health practitioner itself is a feat.
But that's nothing. Like I mentioned before - realistically speaking the odds of the person you called being able to take your insurance is probably around 30% assuming you have a large insurance plan. Now the odds of that person accepting your insurance plan AND being competent to practice CBT is probably around 1-2%.
That means 1 out of 100 mental health practitioners will be able to accept your insurance plan and be competent to treat you.
Are you feeling lucky?
Of course these numbers I'm using aren't by any means scientific, they're just based of a small limited pool of psychologists I have researched and done "first visits" with.
It is so darn depressing, the immense backlog of mental health in this country. There is absolutely no reason for patients to have to wait 2-3 months to see a qualified mental health practitioner especially with the intense level of pain they have to suffer with. Then to receive inadequate treatment further compounds the problem as this forces patients to have stay with the practitioner thus preventing other patients from getting in and just compounding the issue of time to treatment further.
The state of mental health treatment options are just so horrendously bad and it is in such a dismal and pathetic state that it erases all doubt from one's mind as to why people with severe mental illness go long periods of time without adequate treatment.
In order to solve the problem, I propose several changes to be made.
I. Change the education pathway of psychologists. Just like there are specialties in medicine, there should be two fields of clinical psychology: one for depressive disorders such as major depression, dysthymia, unipolar depression, atypical depression - and other field for anxiety disorders that focuses solely on CBT-based treatments.
A third field of general psychology dealing with subclinical problems such as social/relationship/behavioral issues should also be a career pathway.
This act alone, would immensely assist in the problems I listed above. First, it would allow prospective patients to identify which type of psychologist they should go to rather than having to guess as to the psychologist's expertise with their problems. This cuts down on "false-start" sessions where a person takes up a valuable appointment time slot and wastes money on a psychologist who really isn't fit to treat them.
Second, it focuses the psychologist's study into the issue they're concerned with treating. This means staying up-to-date on research, gaining solid experience with what works and what doesn't and allowing this constistent exposure to the treatment process to allow them to become experts.
For clinical disorders not well categorized in these fields, these patients should be reserved for psychiatrists who can prescribe medications i.e. illnesses that only respond to medications such as bipolar disorder, clinical depression, schizophrenia, etc etc.
Will write more on this subject later.
CBT is a viable treatment option if it is being practiced by an extremely well experienced and wise practitioner with adequate access to resources such as volunteer people to use in exposure sessions. The wide array of psychologists/PhD in the private practice are so alarmingly underskilled, inexperienced, and full of utter BS that it's not only not helpful to see them, it's HURTFUL to with each sessions charging 200+ dollars?
Seriously? These the people who come down the ladder of liberal arts colleges presumably under the false philosophy of being liberal philanthropists, but it seems in reality they have no qualms indulging the more "pragmatic" aspect of communist philosophy i.e. some people are more equal than others.
I've done the searches in private practice and without exception to all those who claimed under the never ending list of skills to be "CBT experts" were nothing more than pseudo intellectuals who haven't cracked open a recent study of CBT let alone a textbook or any source of information on the subject since they passed their qualifier in graduate school if they even looked at it then. They instead seem to uniformly rally around their own crackpot theories as to how the ole' noggin works and are ever so satisfied implementing their own unscientific "intensive" talk therapy treatments that I wouldn't mind betting my entire valued worth do nothing to alleviate the symptoms of clinical anxiety disorders.
I've been lucky to go into a research clinic at a university, and I know what it takes to make progress in treating social anxiety through this method, and I know that it takes intense commitment and ability to withstand intense pain.
From this learning experience, I know that the vast majority of people who read the CBT studies and think all it takes is a quick call to get on board a program to change their lives are deluding themselves. For one thing, if you call any mental health practitioner in this country - go ahead - you'll find that ~80% aren't accepting new patients and those that are have a >20 day waiting list before you can be accepted.
Just being accepted to see a qualified mental health practitioner itself is a feat.
But that's nothing. Like I mentioned before - realistically speaking the odds of the person you called being able to take your insurance is probably around 30% assuming you have a large insurance plan. Now the odds of that person accepting your insurance plan AND being competent to practice CBT is probably around 1-2%.
That means 1 out of 100 mental health practitioners will be able to accept your insurance plan and be competent to treat you.
Are you feeling lucky?
Of course these numbers I'm using aren't by any means scientific, they're just based of a small limited pool of psychologists I have researched and done "first visits" with.
It is so darn depressing, the immense backlog of mental health in this country. There is absolutely no reason for patients to have to wait 2-3 months to see a qualified mental health practitioner especially with the intense level of pain they have to suffer with. Then to receive inadequate treatment further compounds the problem as this forces patients to have stay with the practitioner thus preventing other patients from getting in and just compounding the issue of time to treatment further.
The state of mental health treatment options are just so horrendously bad and it is in such a dismal and pathetic state that it erases all doubt from one's mind as to why people with severe mental illness go long periods of time without adequate treatment.
In order to solve the problem, I propose several changes to be made.
I. Change the education pathway of psychologists. Just like there are specialties in medicine, there should be two fields of clinical psychology: one for depressive disorders such as major depression, dysthymia, unipolar depression, atypical depression - and other field for anxiety disorders that focuses solely on CBT-based treatments.
A third field of general psychology dealing with subclinical problems such as social/relationship/behavioral issues should also be a career pathway.
This act alone, would immensely assist in the problems I listed above. First, it would allow prospective patients to identify which type of psychologist they should go to rather than having to guess as to the psychologist's expertise with their problems. This cuts down on "false-start" sessions where a person takes up a valuable appointment time slot and wastes money on a psychologist who really isn't fit to treat them.
Second, it focuses the psychologist's study into the issue they're concerned with treating. This means staying up-to-date on research, gaining solid experience with what works and what doesn't and allowing this constistent exposure to the treatment process to allow them to become experts.
For clinical disorders not well categorized in these fields, these patients should be reserved for psychiatrists who can prescribe medications i.e. illnesses that only respond to medications such as bipolar disorder, clinical depression, schizophrenia, etc etc.
Will write more on this subject later.
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